Incidence of anterior tibial spine fracture among skiers does not differ with age

Abstract

Purpose Injury to the anterior cruciate ligament (ACL) is common in alpine skiing in the form of either an intra-substance ACL tear or anterior tibial spine fracture (ATSF). Anterior tibial spine fractures are typically reported in children. However, several case reports describe these injuries in adults while skiing. The purpose of this study is to describe the sport specific incidence of ATSF in alpine skiing. Methods The study was conducted over a 22-year period. Skiers who suffered an ATSF were identified and radiographs were reviewed to confirm the diagnosis. Additionally, control data from intra-substance ACL injury groups were collected. The incidence of these injuries in children, adolescents, and adults (grouped as ages 0-10, 11-16, and 17 + years old, respectively) was evaluated and the risk factors for ATSF versus ACL tear were determined. Results There were 1688 intra-substance ACL and 51 ATSF injuries. The incidence of intra-substance ACL injury was greater in adults (40.0 per 100,000 skier days) compared to the adolescent (15.4 per 100,000) and child (1.1 per 100,000) age groups. In contrast, the incidence of ATSF was similar in the adult (0.9 per 100,000), adolescent (1.9 per 100,000), and child (1.9 per 100,000) age groups. Loose ski boot fit was identified as a risk factor for ATSF. ConclusionThe incidence of ATSF in alpine skiers is similar among all age groups. However, the incidence of intra-substance ACL injuries is far greater in adult skiers compared to adolescents and children. Risk factors for ATSF relate to compliance between the foot/ankle and the ski boot. Level of evidence III.

Anatomical factors associated with the development of anterior tibial spine fractures based on MRI measurements

“…Identifying high-risk individuals through preoperative MRI allows us to individualize treatment and rehabilitation programs to improve postoperative outcomes and avoid reinjury, such as refracture and ACL injury. For individuals at high risk of ATSFs, such as skiers, it is postulated that training athletes to jump, land and cut in a biomechanical position and using appropriate athletic equipment may potentially diminish the incidence of ATSFs [ 9 , 49 ]. Future research will also be warranted to determine if more conservative rehabilitation programs and return-to-sport protocols are necessary for people at high risk of ATSFs.…”

“…The most typical mechanism of injury is knee hyperextension with a valgus or rotational force [ 8 ], often resulting from a fall from a bicycle. But these fractures are increasingly common in noncontact injuries in sports, such as skiing and soccer [ 9 ].…”