How Can I Ski, and Still Save My Knee
After spending my first month here in Telluride, which I affectionately refer to as "WhoVille," I quickly realized the impact of skiing on people's lives is like no place I have ever seen. People watch for the snow conditions more closely than a stockbroker in Chicago would keep an eye on the stock market. Residents, as well as tourists, cherish their ski time so much that a loss of one day, much less an entire season would simply be devastating. As serious as people are about skiing, they are generally afraid of sustaining a hobbling injury. Most citizens of Telluride know at least one person who has suffered the dreaded ACL knee injury. After a brief review of the ACL, I'd like to outline a few simple methods to prevent ACL tears during ski-related falls.
The ACL or anterior cruciate ligament is an important ligament in the knee which prevents the tibia (leg bone) from moving forward relative to the femur (thigh bone). Without it, it is very difficult to do any activities which require pivoting such as skiing, basketball, hiking, and sometimes even everyday walking. ACL tears are a quite common injury seen in skiing accidents. They represent 20% of all skiing injuries. In fact there are about 24,000 ACL tears on ski slopes across America each winter season. In the 1970's, fractures of the tibia were much more common. However, due to advancement from the stiff, high backed boots with straight skis, to more flexible boots with shaped skis, the number of these tibial fractures decreased significantly. Unfortunately there has been a concomitant increase in ACL tears, and little has been done to prevent them.
The mechanism of injury to tear the ACL is usually one of two. The first, less common way is a sudden acceleration/deceleration of one's leg so that the ACL is stretched until it tears. For example if one were to land a big jump on the slopes, and the rest of their body would continue forward. The other much more common mechanism is most easily remembered by POP-Pivoting Out of Position. This generally involves the leg (or ski) acting as a fulcrum, staying in place while the femur and rest of body continue in another direction, creating significant stress on the ACL until POP!!…it tears.
Generally, the symptoms that are most classic for an ACL tear include a history as above, an audible pop, significant swelling within the first 24 hours, sensation of instability, and anywhere from minimal to excruciating pain. It is usually most prudent to see a doctor immediately as walking on an unstable knee could cause more damage to other vital structures inside the knee including the cartilage. A doctor will take a history regarding your fall, probably some x-rays to rule out some more serious associated fractures, and then a few simple but important physical exam maneuvers to help determine the extent of your injury.
If indeed your ACL is torn, surgery is usually the best option for those who wish to return to their previous activities. Generally patients are able to return to activities anywhere from 4-12 months after surgery, depending upon how the surgery went, rehab, and motivational level of the patient. These surgeries generally have excellent results, often approaching about a 95% success rate, with only a few complications.
How do you prevent ACL tears and having to go through all the work of surgery and rehab? There really is no way to prepare oneself for an injury, however there are a few simple things a skier can do during a fall to prevent this difficult injury. A large 3 year study was done recently in the east coast to try to teach skiers how to fall properly. 22 resorts participated in the study where skiers simply had to watch a brief video on the proper way to fall, which was then reinforced by ski instructors. 20 resorts who did not do the above, served as a control. The results were astonishing!! There was a 62% decrease in the number of serious knee injuries for those who received the training! (The video can be ordered by FAX (802) 899-3677, or go to www.vermontskisafety.com).
The advice is quite simple: 1.) Keep your hands forward, 2.) Don't try to stand up, if you start falling, and don't fall backwards if you do begin to fall, 3.) Don't straighten your legs if you begin to fall, 4.) Don't try to stop your slide with your ski edge after you've fallen, 5.) Keep your skis parallel and together if you do end up falling. It seems pretty basic, but each of these tips plays a significant role in reducing the possibility of producing more torque on the ACL, and therefore less chance of a tear. My guess is ultimately, ski designers will search to find a new model that decrease your chances of a serious knee injury, thereby making the most popular winter sport here even more enjoyable!
Special thanks to Josh Lerman, Skiing Magazine editor, author of "Oh Knee, Oh My", Dec. 2000 issue.
Neeru Jayanthi, M.D.
