ACL Injuries and Downhill Skiing

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The ACL, or anterior cruciate ligament, is a ligament located inside the knee joint. It is a major connector of the femur and the tibia and one of the key parts of the joint for maintaining a stable, yet flexible knee.

Causes

ACL injuries are caused by several factors. One of the most common causes is a twisting force being applied to the knee, causing it to buckle, which can happen with or without a collision. Skiers are particularly susceptible to these types of strains when landing jumps, skiing moguls, or during twisting falls.

The injury can also occur due to a contact force such as being hit from the front or side. ACL injuries can also happen during a fall by a novice skier, when the bindings do not release.

Symptoms

Patients commonly report that they hear an audible "pop" at the time of the ACL injury immediately followed by brief, acute pain. Swelling, pain, and instability of the knee are common.

You may experience difficulty supporting your weight when standing and the knee may feel as though it will give out. If you experience any of these symptoms, you should have a friend flag down the ski patrol and head to a healthcare provider immediately. An MRI is usually used to diagnose an ACL tear, but your doctor can often detect this based on physical examination alone.

Prognosis

Once the swelling has subsided, it is possible to function with even a complete tear. However, you may have to limit your sporting activities and you may be at risk for the knee collapsing during twisting or pivoting activities. The injury can often require surgical reconstruction in an athletic person. Recovery from surgery can take many months and a skier may take longer than a year to return to skiing.  

Treatment

Depending on the severity of the injury, recovery can involve physical therapy, a brace, or surgical reconstruction of the ligament. The initial treatment of an acute ACL injury often includes ice, anti-inflammatory medication, and physical therapy which is directed at restoring the range of motion and reducing swelling in the injured knee. 

A complete tear in a young athlete can often require surgical reconstruction of the ACL. This is a common procedure with a relatively high success rate. The most common types of ACL reconstruction involve harvesting either the central third of the patellar tendon or part of the hamstring tendons. 

Nevertheless, surgery is never an appealing thought. There are many factors to consider when deciding if surgery is necessary. Do your own research on the subject and talk with your doctor. Be sure to get all of your questions answered before committing to surgery.

There is generally a long recovery period. Therapy will begin in a few days and progress over the months until low-impact exercises can be done with any intensity. It could take a year before you are back on skis.

Prevention

There are several things you can do in the preseason and off-season to decrease your risk of an ACL injury.

  • Do conditioning and strengthening exercises of the quadriceps and hamstring before ski season starts. Strong and coordinated muscles that support the knee during activities can be important in minimizing risk of injury. 
  • Ski easier at the end of the day, when you are typically fatigued. Avoid difficult trails, big air, lots of moguls, and speed skiing on ice. Take it easy in the late afternoon.
  • Do regular stretching exercises for the hamstrings, quadriceps, hip, back, shoulder. The more you stretch, the less likely you are to strain or pull a muscle.
  • Use gear that is fit to you and is tuned up.
  • Check your bindings for release tension. Do not set them too tight.
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