Knee Injuries Are the Most Common Injury on the Slopes Each Year

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Knee Injuries Are the Most Common Injury on the Slopes Each Year
Sports orthopaedist Kevin Plancher, MD on recognizing and treating injury

NY, NY and Greenwich, CT, October 2008 “ It is estimated that each year more than a half a million people will suffer a ski-related injury on the slopes. The most common occurrence, accounting for 30-40% of ski-related injuries each year, is an injury to the knee. While preventive pre-season steps like physical conditioning, equipment checks and refresher lessons can reduce the risks, recognizing the injury when it occurs on the slopes and treating it properly is the best way to quicken recovery time and increase the chances of a return to the slopes before the end of the season.

A ski-related knee injury can be as innocuous as a slight sprain or as devastating as a full ligament rupture of the anterior cruciate ligament. And recognizing the difference right away is the first step in ensuring a good recovery, explains Kevin Plancher, MD, a leading sports orthopaedist in the New York metropolitan area and an official orthopaedic surgeon for the U.S. Ski and Snowboard teams. It’s not uncommon for active adults to downplay an injury, in an effort to work through it or out of a desire to continue an enjoyable activity like a day of skiing, Dr. Plancher reveals. But some injuries will only worsen if they are not recognized immediately and treated properly, he warns.

Pop Goes the Ligament
In the world of ski-related knee problems, ligament injuries are king. The Anterior Cruciate Ligament and the Medial Collateral Ligament are the two structures that hold the knee joint in place between the femur and the tibia. Injuries to these two ligaments account for nearly half of all knee injuries on the slopes. Ironically, changes to the design of boots, bindings and skis to prevent the too-common leg fractures of the 1970s and have often been the culprits in ski-related knee injuries.

However, today ski and boot designs are beginning to reverse this trend. Soft boots that allow the ankle more flexibility are overtaking the stiff, unwielding boots of the past, while shorter, hourglass-shaped skis with wider fronts and backs and a thinner binding area are considered the latest and greatest in ski design. These new boot and ski designs are the tools needed to practice the carving technique in skiing, where acceleration and turning are controlled through subtle and fluid movements of the feet and ankles, rather than through skidding, jarring movement of the ski itself. Experts believe that carving can make for a more enjoyable and safer skiing experience. However, as is the case with learning any new skiing technique, the training or retraining period can be a time when risk of injury is greater, particularly to the knee area.

Ligament injuries can be easy to recognize, because they often involve a popping sound that lets the skier know what has happened, Dr. Plancher explains. However, there are times when a torn or ruptured ligament won’t pop, and so the skier must rely on a number of other symptoms in order to properly recognize the injury, Dr. Plancher adds. Additional signs of a ligament injury include:

1. Immediate searing pain, followed by a dull, painful sensation in the knee
2. Swelling around the knee immediately
3. Difficulty bearing weight on the knee
4. A wobbly sensation, as though the kneecap is floating and/or out of place

Less common and/or less severe knee injuries often sustained during skiing or snowboarding include a broken kneecap (usually the result of force trauma to the knee after colliding with or falling onto something hard like a tree or a rock) and ligament sprains and strains of varying severity.

Key Treatment Approaches for Ski-Related Knee Injuries
When the ACL or MCL is torn, ruptured, or even severely strained, it’s critical to begin treatment right away, Dr. Plancher advises. Because of their limited blood supply, some ligaments do not repair themselves or heal properly on their own, he explains. Adding when treatment of ligament damage is delayed, it can increase the need for more aggressive treatment down the line, compromise the chance of a full recovery, lengthen the skier’s return to the sport, and even lead to severe arthritis in the joint. But successful treatment of ACL will get you back for the next ski season.

Initial treatment of all knee injuries should begin with RICE “ Rest, Ice, Compression and Elevation“ and commence to a consultation with an orthopaedist within 24 hours if symptoms persist or worsen during the first six to eight hours. Often the best option for patients who wish to return to an active lifestyle after a knee injury is arthroscopic reconstruction of the ligament, Dr. Plancher explains. The minimally-invasive procedure is usually done in a same-day surgery facility, and involves grafting tendons from the patella or hamstring to replace the torn or ruptured ligaments. With successful surgery, physical therapy and bracing equipment “ which can reduce the risk of reinjury by nearly 300%“ an early season ski injury may not be a season-ending injury after all, Dr. Plancher notes.

*American Journal of Sports Medicine, October 2006