Ski Related Knee Injuries
This article is by the physiotherapist in Islington at the Angel Sports Injury and Physiotherapy Clinic. This article looks at knee injuries from skiing and this will be followed by an article on ‘get fit for skiing and prevent injury
• Mechanism of injury
• Classification of ligamentous injury
• Medial and Lateral Collateral ligaments
• Meniscal tears
Skiing for most of us is a once a year event and unless we have been consistent over the year with respect to exercise and maintaining fitness there is a risk of injury as the skiing holiday progresses.
There are numerous skiing injuries that can be sustained but knee injuries are the most common and can be the most significant. These can be the more severe injuries such as the rupture of the anterior cruciate ligament or to the less severe straining of the lateral or medial collateral ligaments.
Like all ligamentous injuries ascertaining the mechanism of injury is essential and also assessing the individuals’ ability on skis will aid the diagnosis. If you can determine the direction the lower leg went in during the accident you can deduce the tissues injured and if you can determine the velocity of the incident you get an idea as to the severity of the injury.
Beginners tend to do snow plough turns. This can result in medial collateral knee ligament injury as it requires quadriceps strength to maintain control. As the stance gets more exaggerated and the skis get further apart in an attempt to slow down, and we have all done this when starting to ski or have seen it, more and more strength is required form the quadriceps to keep control of the skis. When the skis get further apart and the quadriceps start to fatigue there is more chance that control of the skis can be lost and a twisting injury result.
As the skier improves in technique there is a change towards a parallel turn and skis are kept together or parallel as in a carving turn. This is more efficient than doing a parallel turn but increases the speed of the turn and naturally any injury will be more severe.
Classification of ligamentous injuries
• Grade 1 - No ligamentous laxity on stressing the joint. Minor tears to ligament fibres.
• Grade 2 - Some ligamentous laxity but definite end point joint integrity maintained. Some damage to ligament fibres.
• Grade 3 - Complete give in the ligament. All ligament fibres torn and lack of integrity to joint. Swelling within an hour and blood in the joint
The assessment of the injury and the determination of the degree of ligamentous laxity can be done 5-7 days after the injury and once the initial inflammation has subsided.
Medial collateral knee ligament sprain
This type of sprain is the most common ski injury making up 25% of all injuries. Most commonly affects beginner and low-intermediate skiers and the injury. With beginner it often results from a ‘snowplough’ when the knees get stressed in an inward direction and falling with the skis crossed or for intermediate skiers the medial collateral ligament gets sprained when the an edge gets caught and forces the leg into external rotation.
Grade one and two sprains should be treated with extension of the knee until the swelling has gone down. Grade 3 tears may need surgical intervention.
Anterior cruciate knee ligament sprain (ACL)
This injury accounts for 10-15% of all ski injuries. It is often diagnosed late due to other knee injuries and can be missed to miss at the time.
There are three main mechanisms of injury that can lead to ACL damage.
• backward twisting fall
• forward twisting fall
• boot-induced anterior draw
The most common injury mechanism is the forward twisting fall. It is the number one mechanism of ACL injury for those using carving skis. It occurs when the skier moves forwards relative to the ski (such as when catching an edge whilst turning). The resulting bending movement is applied as the affected leg twists and rotates outwards and the forces generated rupture the ACL.
These make up approximately 5 –10% of all ski injuries and often occur with other injuries. The lateral meniscus is usually involved due to the internal twist in the weight bearing knee and usually the result of catching an edge at speed.
With the frequency of knee injuries in skiing it is important to rehabilitate old knee injuries and then prepare for the next skiing holiday thoroughly. Our physiotherapist will assess your old injury and look at the function of the knee and prescribe a course of treatment and rehabilitation to strengthen the knee and decrease the risk of injury recurrence.
If you are a skier and have had knee injuries in the past and you want an assessment from a physiotherapist in Islington call the Angel Sports Injury and Physiotherapy Clinic for an appointment or click below.