Anterior cruciate ligament injury in elite Alpine competitors.

Balance in Alpine skiing is dynamic and tenuous. Loss of balance typically leads to the accumulation of forces that create severe bending moments at the knee. The modern ski binding, while effective at protecting the ankle and lower leg, is much less effective at protecting the knee. The result: knee injuries have increased nearly three-fold since 1972 with anterior cruciate ligament (ACL) injuries currently accounting for approximately 10% of all skiing injuries. The mechanism of ACL injury in elite competitors is distinct from recreational skiers and is typically associated with a characteristic, deeply flexed, seated body position, with the feet accelerating forward relative to the upper body. The risk of ACL injury in elite skiers is compounded by the functional characteristics of the modern ski binding and further exacerbated by the protocols used to set release tension for competition. It is apparent that the physical abilities of the elite competitor, combined with modern ski technique and equipment, expose the skier to forces that the human body cannot tolerate. Presently, the only solution to the problem would appear to be the development of "smarter" bindings and/or the adoption of standards that set limitations on performance for the sake of safety.