Mechanisms of anterior cruciate ligament injury in world cup alpine skiing:​ a systematic video analysis of 20 cases

Bere, Tone; Flørenes, Tonje Wåle; Krosshaug, Tron; Koga, Hideyuki; Nordsletten, Lars; Irving, Christopher; Muller, Erich; Reid, Robert Cortas; Senner, Veit; Bahr, Roald

Affiliations

¹Oslo Sports Trauma Research Center, Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway

²Section of Cartilage Regeneration, Tokyo Medical and Dental University, Tokyo, Japan

³Orthopaedic Department, Oslo University Hospital, Oslo, Norway

⁴University of Oslo, Oslo, Norway

⁵Canadian Sport Centre Calgary, Calgary, Alberta, Canada

⁶Department of Sport Science and Kinesiology, University of Salzburg, Salzburg, Austria

⁷Department of Physical Performance, Norwegian School of Sport Sciences, Oslo, Norway

⁸Department of Sport Equipment and Materials, Technical University of Munich, Munich, Germany

Abstract and keywords

Background: There is limited insight into the mechanisms of anterior cruciate ligament injuries in alpine skiing, particularly among professional ski racers.

Purpose: This study was undertaken to qualitatively describe the mechanisms of anterior cruciate ligament injury in World Cup alpine skiing.

Study Design: Case series; Level of evidence, 4.

Methods: Twenty cases of anterior cruciate ligament injuries reported through the International Ski Federation Injury Surveillance System for 3 consecutive World Cup seasons (2006-2009) were obtained on video. Seven international experts in the field of skiing biomechanics and sports medicine related to alpine skiing performed visual analyses of each case to describe the injury mechanisms in detail (skiing situation, skier behavior, biomechanical characteristics).

Results: Three main categories of injury mechanisms were identified: slip-catch, landing back-weighted, and dynamic snowplow. The slip-catch mechanism accounted for half of the cases (n = 10), and all these injuries occurred during turning, without or before falling. The skier lost pressure on the outer ski, and while extending the outer knee to regain grip, the inside edge of the outer ski caught abruptly in the snow, forcing the knee into internal rotation and valgus. The same loading pattern was observed for the dynamic snowplow (n = 3). The landing back-weighted category included cases (n = 4) where the skier was out of balance backward in flight after a jump and landed on the ski tails with nearly extended knees. The suggested loading mechanism was a combination of tibiofemoral compression, boot-induced anterior drawer, and quadriceps anterior drawer.

Conclusion: Based on this video analysis of 20 injury situations, the main mechanism of anterior cruciate ligament injury in World Cup alpine skiing appeared to be a slip-catch situation where the outer ski catches the inside edge, forcing the outer knee into internal rotation and valgus. A similar loading pattern was observed for the dynamic snowplow. Injury prevention efforts should focus on the slip-catch mechanism and the dynamic snowplow.

Keywords: anterior cruciate ligament (ACL) injury; injury mechanism; alpine skiing; professional ski racer; video analysis

Links

DOI: 10.1177/0363546511405147

PubMed: 21515807

WoS: 000292375300007

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Cited By (3)

Year	Entry
2014	Kent RW, Lievers WB, Riley PO, Frimenko RE, Crandall JR. Etiology and biomechanics of tarsometatarsal injuries in professional football players: a video analysis. Orthop J Sports Med. March 2014;2(3):2325967114525347.
2016	Ha CWS. A Subject-Specific Computational Model to Investigate an Ankle Inversion Ligamentous Sprain Injury and Evaluate the Intelligent Anti-Sprain System [PhD thesis]. The Chinese University of Hong Kong; October 2016.
2017	Jordan MJ. Neuromuscular Function and Performance in Alpine Ski Racers With Anterior Cruciate Ligament Reconstruction: A Return to Sport Framework [PhD thesis]. Calgary, AB: University of Calgary; March 2017.