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OAS Health Blog

Knee ACL injuries and Skiing

January 9, 2014

With her previous Olympic and World Cup performances and Madison Avenue's attention, Lindsey Vonn was to have been the face of the United States Olympic team at Sochi. If nothing else, she has become the present face of ACL, or anterior cruciate ligament, tears in skiers. However, unlike Vonn, you need not go 85 MPH on a downhill race course to suffer an ACL tear, or another knee injury.

Knee injuries are the most common injury to skiers. They can make up to 40% of all injuries. Among these knee injuries, ACL tears are common. A report in 1987 demonstrated that at least one ACL tear was diagnosed at a typical ski area in Wyoming each day over a 120 day season. Multiplied by the 570 registered ski slopes in the US, that means there are at upwards of 68,000 ACL injuries a year, in skiers alone.

The ACL, along with its brother ligament the PCL, is located in the middle of the knee. It connects the thigh bone, the femur, to the leg bone, the tibia. It provides primary stability to the knee and prevents translation of the lower leg forward. When a strong force is applied to the knee in a forward direction, the strain on the ACL can be too much and the ligament can be torn.

Most ACL tears in skiers occur as the result of a backward, or sitting, or clumsy fall. Being in a sitting position, especially with your hips below your knees, puts additional stress on the ACL and being in this position going through bumps, or landing from a jump, can overload the ACL and lead to a tear. The Phantom Foot phenomenon has been described to explain these ACL tears. The uphill ski lands on its tail and the ski and the boot act as a lever and the resulting shift, twist and bend forces disrupt the ligament. Often "catching an inside edge" and doing this with the hips and knees too bent, and the lower leg pulled too far, can result in the ACL injury.

Fortunately, there are things that can be done to minimize the risk to the ACL when skiing. Prior to starting your ski season, strength training and aerobic training are very helpful. These will help to minimize fatigue while skiing and provide strength to enable maintenance of appropriate technique. Additionally, attention to proper technique can significantly reduce the risk to knee injuries.

Unfortunately, despite the best technique and attention to training and detail, accidents occur. ACL tears need not mean the end to your skiing career, or participation in other sports. ACL reconstruction surgery techniques have evolved significantly with all minimally invasive arthroscopic techniques that take about an hour, with most patients able to return fully to their pre-accident level of function. After a knee injury while skiing, early evaluation by an orthopaedic sports medicine specialist is critical to ensure absence of other significant injuries and to establish a plan that will enable you to be back on the slopes as soon as possible.

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