Alpine ski bindings and injuries. Current findings.

In spite of the fact that the overall incidence of alpine ski injuries has decreased during the last 25 years, the incidence of serious knee sprains usually involving the anterior cruciate ligament (ACL) has risen dramatically since the late 1970s. This trend runs counter to a dramatic reduction in lower leg injuries that began in the early 1970s and to date has lowered the risk of injury below the knee by almost 90%. One of the primary design objectives of modern ski boots and bindings has been to protect the skier from tibia and ankle fractures. So, in that sense, they have done an excellent job. However, despite advances in equipment design, modern ski bindings have not protected the knee from serious ligament trauma. At the present time, we are unaware of any binding design, settings or function that can protect both the knee and lower extremities from serious ligament sprains. No innovative change in binding design appears to be on the horizon that has the potential to reduce the risk of these severe knee injuries. Indeed, only 1 study has demonstrated a means to help reduce this risk of serious knee sprains, and this study involved education of skiers, not ski equipment. Despite the inability of bindings to reduce the risk of severe knee injuries there can be no doubt that improvement in ski bindings has been the most important factor in the marked reduction in incidence of lower leg and ankle injuries during the last 25 years. The authors strongly endorse the application of present International Standards Organisation (ISO) and American Society for Testing and Materials (ASTM) standards concerning mounting, setting and maintaining modern 'state of the art' bindings.

Skiing injuries in children, adolescents, and adults.

We prospectively gathered data on skiing injuries that had been sustained at the Sugarbush North ski area since 1972 and at the Sugarbush South ski area since 1981. The purpose of the current study was to document the overall rates of injury in children, adolescents, and adults participating in alpine skiing. We also sought to determine the ten most common injuries in each age-group. Finally, we analyzed short-term and long-term trends to determine if changes in equipment had had an effect on the frequency or pattern of injury. From the 1981-1982 to the 1993-1994 season, there were 2.79 injuries per 1000 skier days: 4.27 injuries in children, 2.93 in adolescents, and 2.69 in adults. During the last eight years of the study, the most common injuries were a contusion of the knee in children, a sprain of the ulnar collateral ligament of the thumb in adolescents, and a grade-III sprain of the anterior cruciate ligament in adults. The short-term trends revealed that, in children, the frequency of tibial fractures decreased 10 per cent while that of fractures of the upper extremity increased 8 per cent. The long-term trends showed that, in adults, the rate of tibial fractures decreased 89 per cent while that of injuries of the anterior cruciate ligament increased 280 per cent. The overall rate of injury decreased 43 per cent from the beginning of the study in 1972 to the end of the study in 1994; the decrease was 58 per cent in children, 45 per cent in adolescents, and 42 per cent in adults. Data on the types of equipment and the binding-release values were collected prospectively from injured skiers and from 2083 non-injured skiers. Of the fifty-nine skiers who sustained a spiral fracture of the tibia, forty-two (71 per cent) had binding-release values that were higher than the average for the uninjured group. We believe that the use of properly functioning modern equipment will decrease the rate of injury, particularly in children.

Impact of super sidecut skis on the epidemiology of skiing injuries.

Concerns about whether a new type of ski--the super sidecut or carving ski--has the potential to significantly alter the incidence and type of skiing injuries have arisen in the past two years. These skis have become extremely popular during the past ski season. A case control study of skiing injuries done in a serial fashion at a Northern Vermont ski area since 1972 offers the potential to monitor changes in skiing injuries as these skis increase in popularity. Only during the last ski season have a significant number of skiers in our study (approximately 18% of all) utilized these skis. Our data reveals that skiing injuries associated with super sidecut skis occurred at a higher rate than expected in comparison to conventional skis. We also have observed that expert skiers using super sidecut skis apparently have higher than the expected incidence of ski injuries. It is hoped that in another season or two of continued study that stronger statements can be made and that the preliminary trends we have observed can be confirmed or refuted.

A method to help reduce the risk of serious knee sprains incurred in alpine skiing.

The incidence of severe anterior cruciate ligament sprains was once only a third the current rate. This fact led the authors to believe a means to help reduce the risk of anterior cruciate ligament injury among skiers might be found. Using videotapes of the occurrences of anterior cruciate ligament sprains in alpine skiers and the data associated with more than 1400 anterior cruciate ligament injuries observed in a 22-year study, the authors identified two common mechanisms of anterior cruciate ligament injury. From this information, a study was designed to determine if training could help reduce the risk of anterior cruciate ligament sprains. During the 1993 to 1994 season, the on-slope staff from 20 ski areas participated in a training program involving viewing videotaped scenes where knee injuries occurred. Data from 22 ski areas, where staff were not exposed to the training, were assembled to form a control group. Data concerning anterior cruciate ligament injuries were collected from both groups for the three seasons 1991 to 1994. A total of 179 serious knee sprains were evaluated. Serious knee sprains declined by 62% among trained patrollers and instructors compared with the two previous seasons, but no decline occurred in the control group.

Downhill skiing injuries in children.

The objective of our study was to compare injuries sustained by a large group of children to those of injured adults and a control population of skiers selected from the Sugarbush North ski area in northern Vermont. We reviewed all 3182 injuries which occurred over nine ski seasons (1972 to 1973 through 1980 to 1981) at Sugarbush North. Six hundred and ninety-six (22%) of these injuries occurred in children 16 years of age or younger. For all injuries combined, those under 11 years of age had the same rate of injury as adults. Adolescents had a higher injury rate. Foot and ankle injuries were more common in younger children. Knee injuries made up one-fifth of all injuries in all age groups and in older skiers tended to be relatively more serious. Tibia fractures were more prevalent in younger skiers and declined in all age groups over the period of study. Head and spine injuries comprised 6.2% of the pediatric injuries, and were more prevalent in children than in adults. Upper body injuries were less common in children than in adults. We found height, weight, and proximal tibial diameter to vary with age, but in any given age group there was no significant difference with injury type or the controls. Skiers with less skill or experience had a higher incidence of injuries than more experienced skiers or the control population. Injured skiers in all age groups were less likely to own their equipment. Adjustment of equipment by a professional or the skier did not vary with age or injury type.

Trends in skiing injuries. Analysis of a 6-year study (1972 to 1978).

The trends in skiing injuries showed a decrease during a study conducted over six seasons, 1972 to 1978, at a Vermont ski resort. Over 11,000 interviews were conducted and nearly 1,000 control skiers were evaluated. The injuries totaled 1,711 in 407,600 skier days. Upper body injuries (pelvis, trunk, neck, head, and upper extremities) totaled 713 (42%) and lower extremity injuries totaled 998 (58%). Eighty percent of the lower extremity injuries were classified as (potentially) equipment related. The overall injury rate decreased 41% (upper body, 25%; lower extremity equipment-related (LEER), 43%; and lower extremity nonequipment-related rate was down 71%). Knee sprains did not decline as rapidly as the tibial fractures and ankle sprains. An increase in the relative frequency of properly functioning equipment is primarily responsible for the decline in LEER injuries. Although the relative frequency of properly adjusted bindings is increasing, more than one-half of the equipment in use is still set higher than recommended. Cooperation between all individuals responsible for equipment design, manufacture, installation, and use must continue, if further improvements in alpine skiing safety are to be realized.