Impact of Environmental Factors on the ACL Injury Risk in Recreational Alpine Skiing.

In recreational alpine skiing, an ACL injury represents the most common injury. Skiing is a complex activity where the skier interacts with the environment, such as weather, snow conditions, temperature, etc. Thus, the aim of this study was to evaluate the potential impact of environmental factors on ACL injury risk in recreational alpine skiers. Among a cohort of 392 ACL-injured skiers and 392 uninjured controls matched for sex and skiing skill, environmental factors were collected by questionnaire. Factors included weather conditions, snow conditions, perceived temperature, and slope difficulty at the time-point of the accident (ACL-injured skiers) or of questioning during the ski day (uninjured controls).Multiple logistic regression revealed that in addition to age, five environmental factors were significantly predictive of an ACL injury: fresh snow (OR 10.5), grippy snow (OR 7.8), icy slope condition (OR 12.4), very cold/cold perceived temperature (OR 1.6), and skiing on easy slopes (OR 6.9). In conclusion, besides age, environmental factors such as fresh and grippy snow, icy slope conditions, low temperatures, and flat slopes are associated with an increased ACL injury risk in recreational alpine skiing. Those factors are at least partly modifiable and should be taken into consideration for preventive strategies.

Skill-Specific Differences in Equipment-Related Risk Factors for ACL Injury in Male and Female Recreational Skiers.

Background: In recreational alpine skiing, the anterior cruciate ligament (ACL) is affected in approximately 50% of serious knee injuries. There are established sex-based and skill-based differences in ACL injury risk, but the potential impact of equipment used (eg, skis, bindings, and boots) has not been evaluated. Purpose: To evaluate individual and equipment-related risk factors for an ACL injury depending on sex and skill level. Study Design: Case-control study; Level of evidence, 3. Methods: This was a retrospective questionnaire-based, case-control study of female and male skiers with and without ACL injuries during 6 winter seasons (from 2014-2015 to 2019-2020). Demographic data, skill level, equipment specifications, risk-taking behavior, and ownership of ski equipment were recorded. Ski geometry (ski length; sidecut radius; and widths of the tip, waist, and tail) was taken from each participant's ski. The standing heights of the front and back part of the ski binding were measured using a digital sliding caliper, and the standing height ratio was calculated. Abrasion of the ski boot sole was also measured at the toe and heel. Participants were divided by sex into less and more skilled skiers. Results: A total of 1817 recreational skiers participated in this study, of whom 392 (21.6%) sustained an ACL injury. A greater standing height ratio and more abrasion at the toe of the boot sole were associated with increased ACL injury risk in both sexes, independent of the skill level. Riskier behavior increased the injury risk only in male skiers, independent of the skill level, and longer skis increased the injury risk only in less skilled female skiers. Older age, the use of rented/borrowed skis, and more abrasion at the heel of the boot sole were independent risk factors for ACL injury in the more skilled skiers of both sexes. Conclusion: Individual and equipment-related risk factors for an ACL injury partly differed according to skill level and sex. Consideration of the demonstrated equipment-related factors should be implemented in order to reduce ACL injuries in recreational skiers.

A Comparison of ACL Injury Risk, Ski Geometry and Standing Height Parameters between Skiers with Rented and with Owned Skis.

AIM: to evaluate if ACL injuries are associated with recreational skiers using rented skis and whether individual factors, ski geometry parameters and standing heights differ between skiers who rented or owned skis. A retrospective questionnaire-based, case-control study of ACL-injured and uninjured recreational skiers was conducted during six winter seasons. Age, sex, body height, body weight, nationality, ownership of skis, skill level, risk-taking behavior, ski length, side-cut radius, widths of the tip, waist, and tail, and the standing heights at the front and rear components of the ski binding were assessed. Additionally, ratios between ski widths and a standing height ratio were calculated. Altogether, 1780 skiers (48.9% females) with a mean age of 39.2 ± 13.0 years participated, of whom 22.0% sustained an ACL injury and 32.3% rented skis. ACL injury risk was significantly associated with rented skis (OR 3.2, 95% CI 2.5-4.0). Compared to skiers using own skis, participants who rented skis were more likely female, smaller and lighter, tourists, less skilled and more cautious. In comparison to owned skis, rented skis showed significantly lower mean values in ski length, side-cut radius, ski widths, and for the three ski widths ratios. Additionally, standing heights were significantly lower while standing height ratio was higher for rented skis. Beside individual factors, equipment-related factors should be considered when renting skis in order to reduce ACL injury risk.

Impact of ski geometry data and standing height ratio on the ACL injury risk and its use for prevention in recreational skiers.

OBJECTIVES: To evaluate the impact of ski geometry data and standing height ratio on anterior cruciate ligament (ACL) injury risk of male and female recreational skiers. METHODS: A retrospective questionnaire-based, case-control study of ACL-injured and uninjured recreational skiers was conducted during six consecutive winter seasons. Ski geometry data (ski length, side-cut radius, widths of the tip, waist and tail) were recorded from each participant's skis. Standing heights at the front and rear components of the ski binding were measured with a digital sliding calliper, and the standing height ratio between the front and rear was calculated. RESULTS: A total of 1817 recreational skiers participated in this study, of whom 392 (21.6%) sustained an ACL injury. Multiple logistic regression analysis indicates a higher age, a lower skill level and riskier behaviour as independent individual risk factors associated with an ACL injury. An increase in ski length, tip width of the ski, standing height at the rear ski binding component, and in standing height ratio were found to be independent equipment-related risk factors for an ACL injury. CONCLUSION: Reduced ski length, narrower ski tip width, lower rear standing height and a lower standing height ratio (ie, rear component of the ski binding is more elevated compared with the front component) were associated with a reduced likelihood for ACL injury. When buying or renting skis, these parameters could be considered to reduce the likelihood of ACL injury in recreational skiers.

Ski-geometric parameters do not differ between ACL injury mechanisms in recreational alpine skiing.

PURPOSE: It is not known so far if ski-equipment-related factors differ between the ACL injury mechanisms, potentially influencing the circumstances and causes of falling, finally resulting in ACL injury. More specifically focusing on the injury mechanisms will provide a deeper understanding of injury causation. The aim of the study was to evaluate whether ACL injury mechanisms in recreational alpine skiing differ with regard to ski-geometric parameters, self-reported circumstances and causes of accident and injury severity. METHODS: Among a cohort of 392 ACL-injured (57.9% females) skiers, age, sex, height, weight, skill level, risk-taking behavior, circumstances and causes of accident, and ACL injury severity were collected by questionnaire. Additionally, patients had to recall their type of fall (ACL injury mechanism) by classifying forward and backward falls with and without body rotation. Ski length, side cut radius and widths of the tip, waist and tail were directly notated from the ski. RESULTS: The forward fall with body rotation was the most common reported ACL injury mechanism (63%). A riskier behavior was associated with forward falls without body rotation. Ski-geometric parameters did not significantly influence the type of ACL injury mechanism. Regarding accident characteristics, catching an edge of the ski was more frequent (p < 0.001) the cause for forward falls (75% and 67%) when compared to the backward falls (46 and 15%) and executing a turn was the most frequent action in all falls (39-68%). A complete rupture of the ACL (66-70%) was more commonly reported than a partial tear (30-34%) among all four non-contact ACL injury mechanisms (n.s.). CONCLUSION: In contrast to risk-taking behavior and accident characteristics, ski-geometric parameters and injury severity do not significantly differ between ACL injury mechanisms in recreational skiing. Thus, an individual skiing style seems to have more impact on ACL injury mechanisms than ski equipment. Future studies should evaluate potential effects of ski geometry on the incidence of ACL injury. LEVEL OF EVIDENCE: III.

In recreational alpine skiing, the ACL is predominantly injured in all knee injuries needing hospitalisation.

PURPOSE: The knee joint still represents the most frequent anatomical injury location accounting for about one-third of all injuries in recreational alpine skiers. However, comprehensive information on current knee injury patterns in this populations is sparse. METHODS: During the winter seasons 2016/17 and 2019/20, this retrospective questionnaire-based study was conducted in an Austrian sportclinic situated in a large ski area. Among a cohort of 282 recreational skiers (51.8% females), all injuries were diagnosed by the use of magnetic resonance imaging. Additionally, data were recorded on anthropometric characteristics, the perceived speed at the moment of injury, type of fall, physical fitness, self-reported skill level and risk-taking behaviour. RESULTS: The anterior cruciate ligament (ACL) was injured in all knee injuries recorded. Of the total study sample, 64.5% (n = 182) were ACL injuries with concomitant injuries and about 35.5% (n = 100) were isolated ACL injuries, not involving any other structures of the knee joint. In general, most common concomitant injury diagnoses among ACL-injured recreational alpine skiers were injuries of the medial collateral ligament (MCL) (n = 92, 50.5%), medial meniscus (MM) (n = 73, 40.1%) and lateral collateral ligament (LCL) (n = 41, 22.5%). No significant differences regarding additionally recorded characteristics were found between ACL-injured individuals with concomitant injuries and those with isolated ACL injury. CONCLUSIONS: Whereas, before the introduction of carving skis, the MCL was reported being the most common injured part of the knee, currently, the majority of knee injuries are ACL injuries accompanied by injury of other knee joint structures, i.e. the MCL, MM and LCL. LEVEL OF EVIDENCE: Level III.

Incidences of Fatalities on Austrian Ski Slopes: A 10-Year Analysis.

The study evaluated incidences and potential differences of traumatic and nontraumatic fatalities among recreational skiers and snowboarders on Austrian ski slopes within a 10-year analysis. Within this retrospective study, data were collected by the Federal Ministry of the Interior. Data comprised all traumatic and nontraumatic deaths on Austrian ski slopes which occurred between the 2008/09 and 2017/18 winter seasons. Age, sex, nationality, gear used, altitude, slope difficulty, accident cause, primary cause of death and helmet use were collected at the death scene. Incidence of fatalities was calculated based on number of skier days. In total, 369 fatalities, with an average of 36.9 ± 7.9 fatalities per year, were registered. The yearly incidence of traumatic and nontraumatic deaths decreased by 25.8% and 40.1% during the 10-year time period, leading to an evaluated mean incidence of 0.70 deaths per million skier days, with an incidence of 0.36 traumatic deaths and 0.34 nontraumatic deaths per million skier days. Incidences of both traumatic and nontraumatic deaths decreased during the 10-year analysis, representing death as a rare event on Austrian ski slopes. However, adequate prevention measures to reduce potential risk factors to further reduce the mortality risk on ski slopes are needed.

Are Risk-Taking and Ski Helmet Use Associated with an ACL Injury in Recreational Alpine Skiing?

According to the risk compensation hypothesis, the use of a ski helmet might provide a false sense of security, resulting in a riskier behavior by skiing faster or more aggressively, which might lead to an increased injury risk. Injury of the anterior cruciate ligament (ACL) is a common diagnosis in downhill skiers. Thus, the aim of the study was to evaluate the potential impact of risk-taking and ski helmet use on ACL injury risk in recreational skiing. Eighty-two ACL injured and 446 uninjured skiers with a mean age of 37.3 ± 11.9 years (52% females) were surveyed during the winter season 2018/19 about age, sex, self-reported risk-taking behavior, self-reported skill level, perceived speed, and ski helmet use. Multiple regression analysis revealed that older age (OR: 1.3, 95% CI: 1.2-1.4), riskier behavior (OR: 5.4, 95% CI: 2.8-10.5), and lower skill level (OR: 6.7, 95% CI: 3.4-13.3) were found to be factors associated with ACL injury, while ski helmet use was not. In conclusion, no support for the risk compensation hypothesis was found with regard to ACL injuries. Therefore, we doubt that ski helmet use increases the risk for ACL injury and recommend wearing a ski helmet due to reported protective effects.

Prevalence and potential risk factors of flight-related neck, shoulder and low back pain among helicopter pilots and crewmembers: a questionnaire-based study.

BACKGROUND: Flight-related neck, shoulder and low back pain are the most common musculoskeletal disorders among helicopter pilots and their crewmembers, thus becoming a growing concern. Information on the combined prevalence of these types of pain and related risks are scarce. The aim of this study was therefore to estimate pain prevalence and to evaluate potential risk factors for neck pain among helicopter pilots and crewmembers within the armed forces, the airborne police and airborne rescue organizations in Austria. METHODS: Among a cohort of 104 helicopter pilots and 117 crewmembers (69.8% compliance), demographics, flying experience, use of Night Vision Goggles (NVG), helicopter type flown, prevalence and intensity of musculoskeletal symptoms (pain was defined as any reported pain experience, ache or discomfort) were collected by an online-based questionnaire. RESULTS: For helicopter pilots the 12-month prevalence of neck pain was 67.3%, followed by low back (48.1%) and shoulder pain (43.3%). Among crewmembers, the 12-month pain prevalence were 45.3, 36.8 and 30.8% among the neck, lower back and shoulder, respectively. During this period, 41.8% of these helicopter pilots had experienced 8-30 pain days in the areas of neck (45.7%), shoulder (37.8%) and lower back (42.0%) whereas 47.8% of crewmembers self-reported 1-7 days of neck (54.7%), low back (44.2%) and shoulder (44.4%) pain in the previous year. The 3-month prevalence of neck pain was 64.4% followed by low back (42.3%) and shoulder pain (38.5%) for helicopter pilots. Among crewmembers, 41.9% suffered from neck, 29.9% from low back and 29.1% from shoulder pain the previous 3 months. Multivariate regression analysis revealed NVG use (OR 1.9, 95% CI, 1.06-3.50, p = 0.032), shoulder pain (OR 4.9, 95% CI, 2.48-9.55, p < 0.001) and low back pain (OR 2.3, 95% CI, 1.21-4.31, p = 0.011) to be significantly associated with neck pain. CONCLUSIONS: The 12- and 3-month prevalence of neck, shoulder and low back is considerably high among both, helicopter pilots and crewmembers confirming the existence of this growing concern. The use of NVG devices, shoulder and low back pain in the previous 12 months represent independent risk factors for neck pain. These findings highlight the need for longitudinal studies.

Is ski boot sole abrasion a potential ACL injury risk factor for male and female recreational skiers?

OBJECTIVES: To evaluate the potential impact of ski boot sole abrasion on the ACL injury risk of recreational skiers. METHODS: During the past two winter seasons 2016/17 and 2017/18, this retrospective case-control study was conducted in one Austrian ski area. Among a cohort of 148 ACL-injured (51.4% females) and 455 uninjured recreational skiers (43.3% females), age, sex, height, weight, and self-reported skill level were collected by questionnaire, ski length and sidecut radius were notated and sole abrasion of the toe and heel piece of the ski boot was measured using a digital caliper. RESULTS: ACL-injured skiers showed a higher proportion of female (51.4% vs 43.3%, P < 0.001) and less skilled skiers (48.6% vs 20.9%, P < 0.001), and ski length to height ratio was higher (94.7 ± 3.7 vs 93.8 ± 5.0%, P = 0.019) compared to uninjured skiers. ACL-injured skiers used ski boots of greater abrasion at the toe (4.8 ± 1.8 vs 2.4 ± 2.5 mm, P < 0.001) and heel piece (5.4 ± 1.8 vs 3.3 ± 2.3 mm, P < 0.001) compared to controls. Multivariate regression analysis revealed, beside female sex (OR 6.0, 95% CI, 3.1-11.5, P < 0.001), lower skill level (OR 3.2, 95% CI, 1.9-5.4, P < 0.001) and ski length to height ratio (OR 1.1, 95% CI, 1.0-1.2, P < 0.001), sole abrasion at the toe (OR 1.8, 95% CI, 1.5-2.1, P < 0.001) and heel piece (OR 1.4, 95% CI, 1.2-1.6, P < 0.001) to be independently associated with an ACL injury among recreational alpine skiers. CONCLUSIONS: Based on the underlying findings, ski boot sole abrasion was found to be an independent risk factor and may contribute to an increased ACL injury risk.

Effectiveness of a Mini-Trampoline Training Program on Balance and Functional Mobility, Gait Performance, Strength, Fear of Falling and Bone Mineral Density in Older Women with Osteopenia.

PURPOSE: To evaluate the effectiveness of a combined balance-, strength-, and jumping-exercise intervention on a mini-trampoline performed by older women with osteopenia on static balance and functional mobility, gait speed, strength of the upper and lower limbs, fear of falling, as well as to investigate its influence on bone mineral density (BMD). PATIENT AND METHODS: Using a randomized controlled study design, participants (range: 56-83 years) were assigned either to the intervention group (IG; n=20, mean age 69.6 ± 5.3 years) performing a specifically tailored intervention on a mini-trampoline or to the control group (CG; n=20, 67.4 ± 6.8 years), that did not undertake any intervention beyond regular osteopenia treatment. The intervention was performed twice a week for 12 weeks, each session lasting 45-60 mins and consisted of balance, strength and jumping exercises. Static balance and functional mobility was measured by one-leg stance (OLS) and timed up and go test (TUG). Upper and lower limb strength was evaluated by the arm curl test (ACT) and the 30-s chair stand test (CST) whereas gait speed was measured by the 6 m walking test (WT). Fear of falling was measured using the Falls Efficacy Scale - International (FES-I). BMD was measured at the lumbar spine and femoral neck using Dual-energy X-ray absorptiometry (DXA). RESULTS: Significant interactions (group x time) were found for all parameters (p<0.001) except for BMD, measured at the lumbar spine (p=0.064) and femoral neck (p=0.073). All test parameters of balance and functional mobility tests (OLS, TUG), strength tests (ACT, CST), WT, FES-I and BMD (femoral neck) showed significant improvement in the IG (p<0.05). CONCLUSION: The combined 12-week intervention was highly effective in improving balance and functional mobility, strength, gait performance and fear of falling in patients with osteopenia.

Impact of lowering ski binding settings on the outcome of the self-release test of ski bindings among female recreational skiers.

BACKGROUND AND PURPOSE: The ability to successfully self-release the ski binding can prevent skiing-related injuries of the lower extremities. Failure of binding release associated with a knee injury is significantly higher among females compared to males. The International Standards Organization ISO 11088 standard for binding setting values allows a lowering by 15% upon request of the skier. Thus, the aim of this study was to evaluate the impact of lowered ski binding settings by 15% on the outcome of the self-release test among female recreational skiers. MATERIALS AND METHODS: In this randomized single-blinded study, a cohort of 20 females (24.5±2.7 years) performed the self-release test in the laboratory thrice with each leg under two conditions: 1) with an actual ISO 11088 setting and 2) with a setting lowered by 15%. For each attempt, torques calculated via the force plate were normalized to torques measured by a binding adjustment system (relative release torque, RRT). RESULTS: Among 240 trials in total, more females were significantly able to self-release their ski bindings with lowered binding settings when compared to their actual ISO settings (53% vs 9%, p<0.001). Thirteen females (65%) were able to release their bindings at least once with both legs with lowered binding settings compared to only three females (15%) with their actual binding settings (p<0.001). Mean RRT of all failure of binding release trials significantly differed between lowered and actual binding settings (58.6%±22.2% vs 50.5%±20.4%, p=0.003). CONCLUSION: Four times more females were able to self-release their ski bindings at least once with both legs with a 15% lowered binding setting compared to their normal ISO 11088 setting. The fact that the ISO standard accepts a lowering by 15% upon request of the skier could represent an important measure to prevent knee injuries, especially for female recreational skiers.

[Are there Sex Differences Regarding Ski Length to Height Ratio, Ski Length to Weight Ratio, Sidecut Radius and Ski Boot Sole Abrasion among ACL Injured Male and Female Skiers?] / Unterscheiden sich männliche und weibliche Skifahrer mit einer VKB-Verletzung hinsichtlich der auf die Körpergröße und das Körpergewicht relativierten Skilänge, der Skitaillierung und des Abnützungsgrades der Skischuhsohle?

Introduction Female skiers suffer from knee injuries twice as much as male skiers, and the risk of an injury to the anterior cruciate ligament (ACL) is three times greater among females compared to males. The sex-specific ACL injury risk depends on internal (e. g. age, skiing skills, fitness level) and external (e. g. slope and weather conditions, ski equipment) factors. However, it is not clear whether male and female recreational skiers with an ACL injury differ regarding the sidecut radius and ski boot sole abrasion. Method This questionnaire-based study was conducted in the winter seasons 2014/15 and 2015/16. During those periods, data of ACL-injured skiers were collected at an Austrian ski clinic. The questionnaire included information about demographics, skiing skills, type of fall, binding release, and injury diagnosis. Furthermore, the ski length and sidecut radius were notated from the ski, and abrasion of ski boot sole was measured at the toe and heel piece of the ski boot using a caliper. Results In total 164 ACL-injured skiers (67 % females) with a mean age of 41.7 ±â€Š11.5 years were recorded. Males used significantly longer skies compared to females (168.3 ±â€Š6.6 vs. 157.5 ±â€Š5.9 cm, p < 0.001), however the ski length to height ratio (94.0 ±â€Š3.4 vs. 94.1 ±â€Š3.3 %) showed no significant difference between the two sexes. The ski length to weight ratio was significantly different between females and males (2.5 ±â€Š0.3 vs. 2.0 ±â€Š0.2 cm/kg). The sidecut radius (13.5 ±â€Š1.4 vs. 15.6 ±â€Š2.6 m, p < 0.001) was significantly lower among ACL-injured females compared to ACL-injured males. No sex-specific differences were found regarding the abrasion of ski boot soles, neither at the toe piece (5.4 ±â€Š1.2 vs. 5.5 ±â€Š1.1 mm) nor at the heel piece (6.0 ±â€Š1.7 vs. 6.0 ±â€Š1.6 mm) between females and males. For both sexes the most common type of fall was the forward fall with body rotation (approximately 59 %). Failure of binding release was significantly more often reported by females compared to males (86 vs. 44 %, p < 0.001). Conclusion Female and male skiers with an ACL injury differ regarding the sidecut radius, the ski length to weight ratio, and the proportion of failure of binding release. Moreover, although no sex-specific differences were found regarding the abrasion of ski boot soles, the mean ski boot abrasion was beyond the ISO standard tolerances.

Factors associated with self-reported failure of binding release among ACL injured male and female recreational skiers: a catalyst to change ISO binding standards?

BACKGROUND: Female recreational skiers have twice the rate of knee injuries and three time the rate of ACL injuries compared with their male counterparts. Female skiers suffering from a knee injury reported a significantly higher proportion of failure of binding release than knee injured male skiers. PURPOSE: To evaluate factors associated with failure of binding release among ACL injured male and female recreational skiers. STUDY DESIGN: Cohort study. METHODS: Among a cohort of 498 recreational skiers (68% females) suffering from an ACL injury (complete rupture or partial rupture), age, sex, height, weight, self-reported skill level and self-reported risk taking behaviour, gear origin, ski length, date of last binding adjustment, perceived speed at the moment of injury, type of fall, and failure of binding release of the ski of the injured knee, were collected by questionnaire. RESULTS: Failure of binding release was reported within 78% of cases and was significantly higher for females compared to males (83 vs 66%, p<0.001) with an adjusted OR of 2.7 (95% CI 1.7 to 4.4). A higher perceived speed at the moment of injury was significantly associated with a decreasing proportion of failure of binding release. A slow perceived speed was independently associated with failure of binding release (adjusted OR 2.0; 95% CI 1.2 to 3.5). There was a significantly higher proportion of failure of binding release during backward falling compared to forward falling (87 vs 72%, p=0.002); similarly, a higher proportion of failure of binding release occurred in cases of complete rupture compared with a partial tear of the ACL (81 vs 64%, p=0.001), respectively. CONCLUSIONS: Among this cohort of ACL-injured skiers, failure of binding release was significantly associated with female sex, a slow perceived speed at the moment of injury and complete rupture of the ACL.

Leg dominance is a risk factor for noncontact anterior cruciate ligament injuries in female recreational skiers.

BACKGROUND: In recreational alpine skiing, the knee joint accounts for about one third of all injuries in male and female skiers. However, female recreational skiers have twice the knee injury incidence of male skiers, and the anterior cruciate ligament (ACL) injury risk is 3 times greater in female skiers. PURPOSE: To evaluate whether leg dominance is a risk factor for noncontact ACL injuries in female recreational skiers. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: The relationships between leg dominance, side of knee injury, and gender were analyzed in 65 male and 128 female skiers suffering from a noncontact ACL rupture. RESULTS: Anterior cruciate ligament ruptures of the left knee occurred more frequently in female than in male recreational skiers (68% vs 48%, P = .006). For both genders, in 90%, the right leg was the preferred kicking leg. With regard to leg dominance, female skiers suffered more often from ACL ruptures of their nondominant leg than male skiers (63% vs 45%, P = .020). An adjusted odds ratio of 2.0 (95% confidence interval, 1.0-3.8) was calculated. CONCLUSION: Female skiers showed a 2-fold higher risk of suffering from an ACL rupture on their nondominant leg. Therefore, leg dominance seems to be a risk factor for noncontact ACL injuries in female recreational skiers.

Distribution of injury mechanisms and related factors in ACL-injured female carving skiers.

While ACL injury mechanisms in skiers using traditional skis are well studied, no study has yet investigated the distribution of injury mechanisms in carving skiers. In traditional skiers, the backward twisting fall seems to be the dominant injury mechanism, especially in female skiers. Female recreational skiers have a threefold higher risk to sustain an ACL injury than male skiers; therefore, it is important to determine if carving skis influence the distribution of injury mechanisms and the related frequencies of ACL injuries in female skiers. We investigated the frequencies of injury mechanisms and related factors in 65 ACL-injured female carving skiers by questionnaire. The forward twisting fall was the most reported ACL injury mechanism with about 51%, followed by the backward twisting fall within 29% of cases. Catching an edge of the ski (59 vs. 24%, P = 0.03) when executing turns (69 vs. 41%, P = 0.053) was a more frequent cause for forward twisting falls than for the other types of falling. While 29% of bindings released during a forward twisting fall, only 3.1% released during the remaining mechanisms. In contrast to traditional skiers, the forward twisting fall was the dominant injury mechanism in female carving skiers with ACL injury.

Are oral contraceptive use and menstrual cycle phase related to anterior cruciate ligament injury risk in female recreational skiers?

Oral contraceptive use and menstrual cycle phase are suggested to influence the risk of anterior cruciate ligament (ACL) injuries in female athletes. However, only few data are available for recreational sports. Therefore, female recreational skiers with a non-contact ACL injury and age-matched controls completed a self-reported questionnaire relating to menstrual history, oral contraceptive use and previous knee injuries. Menstrual history data were used to group subjects into either preovulatory or postovulatory phases of menstrual cycle. Our findings suggest that oral contraceptive use did not show any protective effect against ACL injuries nor did self-reported previous knee injuries show any association with ACL injury rate in recreational alpine skiing. Analysis of menstrual history data revealed that recreational skiers in the preovulatory phase were significantly more likely to sustain an ACL injury than were skiers in the postovulatory phase.