Knee-related Skiing Injuries – from Prevention to Treatment

This depends on the skiing conditions. When it is icy, it can be difficult to decelerate, and people tend to fall onto their hands, causing shoulder and wrist injuries. With softer snow, the vast majority of injuries are to the knee, specifically the anterior cruciate ligament (ACL) and medial collateral ligament (MCL).

Those least prepared for their skiing holiday are most at risk. It’s difficult to go from an office environment to spending several hours each day on a ski slope. The physical aspect of skiing requires a combination of core strength, aerobic fitness, proprioception, and balance. To manage this on the slopes, it’s essential to put the training in before your holiday.

The most “dangerous” time is in the afternoon, halfway through your holiday. This is when the fatigue starts to build up, and the untrained skier is most vulnerable to injury.

We’re certainly seeing more knee injuries during the skiing season, and this is due to multiple factors:

• ski design – more modern curved skis tend to “carve” through the snow rather than stick or drag on the snow. This often has the effect of steering the ski away from the body and twisting the knee

• boot design – modern boots do a very good job of protecting the ankles and shins, but this results in more load and rotation being transmitted to the knees.

• poor preparation – skiing is becoming more popular with an increasing number of people without any previous skiing experience, nor adequate fitness training, before hitting the slopes

1. Start your physical preparation at least 6 weeks before your skiing trip. Work on your core muscle strength and aerobic fitness. Regular swimming, cycling and using a cross-trainer would be an excellent start.

2. If you’re new to skiing, take lessons. A good skiing technique minimises your risk of injury.

3. Take a rest day – muscle fatigue reaches its peak 48 hours after you hit the slopes. If you start to feel fatigued after a few days, take a rest day.

4. Don’t drink alcohol at lunchtime – Alcohol increases your confidence and decreases your reactions, a perfect recipe for an injury.

• make sure you have adequate medical insurance before you leave home

• most ski resorts have excellent medical facilities and are very experienced at treating skiing injuries

• if you’re unlucky enough to break a bone, in the majority of cases it makes sense to have these treated (and if necessary operated on) before you fly home.

• if you’re diagnosed with an ACL injury abroad, we advise against having surgery abroad. While ACL injuries are serious, they don’t require urgent surgery. In fact, surgery too soon after injury, while the knee is stiff and swollen, can be detrimental to your outcome and can lead to longer-term problems of stiffness and poor function. It’s also important to remember that not all patients who have torn their ACL require surgery

• if you’re diagnosed with an ACL injury abroad, we advise rest, ice, and elevation, and to see a knee specialist as soon as you can once you’re home. A knee specialist would be able to confirm the diagnosis and go through your treatment options to ensure you have the best possible outcome

• a normal X-ray doesn’t always tell the whole story, and if you continue to have symptoms in your knee after returning home, we advise seeing a knee surgeon for an opinion and review

ACL injuries are very common and are unfortunately becoming more so.

Among women, skiing is the most common cause of ACL injuries.

While an ACL injury is categorised as a serious injury, with significant pain and swelling, the initial treatment is rest, ice, compression and elevation (RICE). If you’ve had a fall on the slopes and injured your knee, it is important to have a clear diagnosis of the injury.

You should see a knee specialist and often an MRI scan will be requested to assess the state of the ACL and also to assess if there are any other injuries (such as a meniscal tear). It’s very common to have other associated injuries alongside an ACL injury.

A knee specialist would be able to advise on the best treatment plan for you, depending on your injury, age, level of activity, and future sporting ambitions. Not all patients require surgery and can get back to a normal lifestyle without surgery. Others, however, may require surgery. Most of the time, surgery is not urgent, and it’s often best to have a period of physiotherapy before surgery to get the best possible outcome.

If surgery is required, it’s important to see a surgeon who has extensive experience of ACL injuries so they can discuss the best individual plan for you to get you back to full function as soon as possible.

In general, they should be treated once you’ve arrived home. Operating on a swollen, stiff knee very soon after a knee injury often results in a poor outcome. In the first few days and weeks following an ACL injury, the priority is to reduce the swelling and increase the range of motion of the knee. Surgery can be safely performed weeks or even months after the initial injury.

The most important thing is to prepare for your skiing holiday so that you can avoid injury, enjoy yourself and have fun skiing!