• ACL Injury: The Scourge of Skiers

    image As Mother Nature blankets the mountains with the cold white stuff, hundreds of thousands of ski enthusiasts head out to the slopes. For most skiers, a day of fun on the slopes is followed by a relaxing evening by the fire or a night about town. Unfortunately, injury cuts the day short for some and ruins the evening and ski year entirely for others. One of the most common injuries is the torn anterior cruciate ligament(ACL).
    Ligaments are strong connective tissues that help connect bones at the joints. The ACL is one of four ligaments that provide stability at the knee joint. It extends from the top of the lower leg bone (tibia) to the bottom of the thigh bone (femur).
    ACL can be damaged in any physical activity but it is a common injury among skiers. Here are some of the actions associated with ACL damage:
    Now you know more about how your knee can be injured. How do you know for sure if you have suffered a torn ACL?


    Damage in the ACL can range from a minor tear to a full rupture. Symptoms will vary by the degree of injury to the ACL, but may include:
    • Pain
    • Popping noise when injury occurs
    • Swelling in the knee within 24 hours
    • Loss of full range of motion
    • Instability—a wobbly feeling that will make it difficult to stand or walk
    These symptoms are usually good indicators of an ACL injury but doctors will usually x-ray the knee to rule out a fracture to the bone. The doctor will also examine your knee to see if there is instability. If a definitive diagnosis is still unclear, an MRI scan may be ordered. This scan can provide detailed pictures of the interior of the knee. In other cases, an arthroscopic exam of the knee may be performed. The doctor will insert tiny cameras into your knee. The cameras will show any damage inside the knee joint.


    If you do suffer a torn ACL, your treatment will depend on your age, activity requirements, and the extent of your injury. Here are the most common treatments:


    Most of these remedies can be done at home:
    • Rest and stay off the knee as much as possible
    • Keep the knee iced and elevated
    • Anti-inflammatory medications (like ibuprofen) will help with pain and swelling
    • Wearing a knee brace to stabilize the knee joint
    If these methods do not work for you, or you are more active, other treatments may be used to help repair your knee and get you back on your feet.


    Surgical treatment involves repairing and rebuilding the ligament. In the past, this surgery required opening the knee to reconstruct the ACL. It was performed with success, but the rehabilitation process was slow. Today, doctors most often perform surgery arthroscopically utilizing small incisions. It can lead to a faster recovery. Here is what to expect during surgery:
    Surgical treatment involves repairing and rebuilding the ligament. In the past, this surgery required opening the knee to reconstruct the ACL. It was performed with success, but the rehabilitation process was slow. Today, doctors most often perform surgery arthroscopically utilizing small incisions. It can lead to a faster recovery. Here is what to expect during surgery:
    • Small incisions are made around the knee.
    • Small surgical tools are inserted through the incisions. The tools will remove the torn ends of the ACL.
    • The ACL will be replaced by a graft. The graft may be taken from patellar tendon (the one that attaches the kneecap to the tibia) or some of the hamstring tendons. The graft is attached to both the lower leg bone and the thigh bone.
    This procedure is very effective because it uses your own tissue and allows the knee to retain its normal range of motion. The knee can heal back to its original degree of strength with a low risk of infection or graft rupture. The reconstruction usually lasts a lifetime, but repeat tears can occur with sufficient stress.
    This type of surgery may require an overnight stay at most, but in many cases, you can leave the hospital the same day.


    Physical therapy programs will help to restrengthen the knee with both conservative and surgical treatments. These programs will help you:
    • Regain range of motion
    • Strengthen the muscles around the knee
    • Improve balance
    • Protect the ligament from further damage
    • Physical training to get you on your skis again
    An ACL brace is generally prescribed for use with any physical activity for some time after the surgery. It will help stabilize the knee while it continues to strengthen.
    Treatment can be effective but considering the pain, inconvenience, surgery, and the lengthy recovery, your best bet is to prevent ACL injuries from happening in the first place. Some prevention tips below might help you avoid injury on the slopes.


    The best way to do this is to strengthen the muscles surrounding the knee, specifically the hamstrings and quadriceps. The reason? These two sets of muscles are crucial in giving a skier the ability to regain balance and control (such as catching an edge during a snowplow). This will help you to prevent the twisting and hyperextension of the knee that can cause the ACL to tear. The hamstrings also control forward motion of the shin bone on the thigh bone, so strength in this muscle group is essential.
    Strength training is one important way to help prevent injury. Here are some others:
    • Ski under control
    • Bend your hips or knees when landing from a jump
    • Warm up before exercising
    Strengthening the leg muscles is particularly beneficial in the months prior to the start of ski season. Consider consulting a sports physician or trainer to try out other exercises and stretches designed to strengthen your knees and the rest of your body. These can improve your performance and lower your risk of injury.


    American Association of Orthopaedic Surgeons http://www.aaos.org/

    The American Orthopaedic Society for Sports Medicine http://www.aossm.org/


    Canadian Orthopaedic Association http://www.coa-aco.org/

    Canadian Orthopaedic Foundation http://www.canorth.org/


    Anterior Cruciate Ligament Injury. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php. Updated November 3, 2012. Accessed November 15, 2012.

    Anterior Cruciate Ligament Injuries. Orthoinfo from American Academy of Orthopaedic Surgeons website. Available at: http://orthoinfo.aaos.org/topic.cfm?topic=a00549. Updated March 2009. Accessed November 15, 2012.

    Anterior Cruciate Ligament Injuries. Teens Health website. Available at: http://kidshealth.org/teen/sports%5Fcenter/injuries/acl%5Finjuries.html#Updated October 2012. Accessed November 15, 2012.

    Anterior Cruciate Ligament Injuries: Treatment and Rehabilitation. Encyclopedia of Sports Medicine and Science website. Available at: http://www.sportsci.org/encyc/aclinj/aclinj.html. Accessed November 15, 2012.

    Skiing Injuries. American College of Sports Medicine website. Available at: http://www.acsm.org/docs/current-comments/skiinginjuries.pdf. Accessed November 15, 2012

    Smith, CM. Anterior Cruciate Ligament Injury. EBSCO Health Library website. Available at: http://www.ebscohost.com/healthLibrary/. Updated September 2010. Accessed November 11, 2010.

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