Health Library

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 a 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 back of the lower leg bone (tibia) to the front 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 sprained or torn ACL?

Symptoms

Damage in the ACL can range from a minor tear (grade 1 sprain) to a full rupture (grade 3 sprain). Symptoms will vary by the grade of the sprain, 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 examine your knee to see if there is instability. The doctor will usually x-ray the knee to rule out a fracture to the bone. If a definitive diagnosis is still unclear, other imaging tests may be necessary, usually an MRI. In some 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.

Treatment

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:

Conservative

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

Surgical treatment involves repairing and rebuilding, or replacing 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 arthroscopic surgery to make repairs.

A graft (usually from a tendon in the knee) can be used to rebuild or replace the ACL. 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.

Surgical treatment involves repairing and rebuilding, or replacing 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 arthroscopic surgery to make repairs.

A graft (usually from a tendon in the knee) can be used to rebuild or replace the ACL. 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.

Rehabilitation

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.

Prevention

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). 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 and knees when landing from a jump
  • Warm up before exercising
  • Make sure your ski bindings are at the correct settings for size and ability

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.

Resources

Ortho Info—American Association of Orthopaedic Surgeons
http://www.orthoinfo.org

Sports Med—The American Orthopaedic Society for Sports Medicine
http://www.sportsmed.org

Canadian Resources

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

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

References

Anterior cruciate ligament (ACL) injury. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated August 19, 2014. Accessed October 22, 2014.

Anterior cruciate ligament (ACL) injuries. American Academy of Orthopaedic Surgeons Ortho Info website. Available at: http://orthoinfo.aaos.org/topic.cfm?topic=a00549. Updated March 2014. Accessed October 22, 2014.

Anterior cruciate ligament injuries. Nemours Kid's Health website. Available at: http://kidshealth.org/teen/sports%5Fcenter/injuries/acl%5Finjuries.html. Updated October 2012. Accessed October 22, 2014.

Skiing injuries. American College of Sports Medicine website. Available at: http://www.acsm.org/docs/current-comments/skiinginjuries.pdf. Accessed October 22, 2014.