Cruciate ligament: watch out for ski injuries

By Cristiano Antonino On Mar 27, 2023

Spring sunshine, at altitude the slopes are still open: a day’s skiing is in order. But in situations where it is wise to be careful

A fall on skis could cause a knee injury, which often results in a serious injury: the rupture of the anterior cruciate ligament (ACL).

This is an injury that may cause joint instability in the knee, as well as swelling and pain.

In such cases, prevention is key, paying attention while skiing and maintaining good muscle tone before putting on the skis.

As any instructor will suggest, when skiing it is always a good idea to perform actions within one’s reach, without overdoing it.

What are the knee ligaments for?

Ligaments are dense, fibrous connective tissue formations that maintain stability between two bone segments.

The ligaments of the knee joint are considered peripheral and intra-articular.

The intra-articular ligaments are the anterior cruciate ligament and posterior cruciate ligament and are located within the joint itself; the peripheral ligaments are placed to reinforce the joint capsule and include the medial collateral, the external collateral, and the posteroexternal and posterointernal ligament complexes, respectively.

Skiing and the dangers to the ligaments

The knee is a very complex anatomical construction to allow it to ‘function’ properly, but it is often at risk of injury, perhaps when practising sports such as skiing without proper training.

The ligaments contribute to the stability of the joint during movement, while the menisci, in addition to functioning as shock absorbers by ‘absorbing’ the forces exerted on the joint, also contribute to joint stability.

The cruciate ligaments, in particular the anterior cruciate ligament (ACL), are often susceptible to rupture precisely because of their position and the role they play within the joint.

The movements that can cause the rupture of one or more of the knee ligaments are easily recognisable:

forced rotations
abrupt stops
sudden changes of direction
direct trauma to the knee area, such as a violent fall or contact, perhaps during sporting activity.

There are also certain ‘constitutional’ skeletal characteristics of the femur and tibia that can increase the risk of ligament rupture.

Ski injuries, cruciate ligament surgery

It is important to choose the right treatment for a ruptured ligament, not only to allow the patient to recover quickly, but also to prevent a second injury.

In fact, failure to reconstruct the injured ligament and properly restore ligament stability increases the likelihood that the knee will suffer a second injury.

Surgery and reconstruction of the injured ligament(s) is the best option for people who are very athletically active or who perform demanding work on their knees.

How is reconstruction of the injured ligament performed?

The operation consists of reconstructing the injured ligament with an autologous tendon tissue graft, i.e. taken from the patient himself, especially in the case of an anterior cruciate ligament injury or, although less frequently, a posterior cruciate ligament injury: in this way, the injured ligament is essentially reconstructed, since repair would be ineffective and often not even possible (precisely because of a biological problem of the inability of the ruptured ligament to repair itself once it has been sutured).

This type of reconstruction is performed using the arthroscopic surgical technique, which is less invasive and also allows associated injuries such as meniscal or cartilaginous injuries to be treated at the same time as the operation itself.

Recovery time after surgery

After surgery, a long recovery period is necessary to allow biological healing of the ligament structures, especially in young adolescent patients.

In fact it is necessary to respect the time required for the ‘maturation’ of the graft used for the reconstruction, in the sense of its complete bio-integration: we are talking about a time that may involve a few months of rehabilitation with a resumption of sports activity that must be progressive and very gradual, in some cases even reaching 9-10 months for very young patients.

However, even with a complete resumption of function, if recovery is forced, the chances of a new traumatic event are very high.

Getting back on skis: how to return to sporting activity after surgery?

In order to return to physical activity, whether professionally or recreationally, perhaps on Sundays when skiing, the patient should undergo a thorough evaluation by not only an orthopaedic specialist but also a physiatrist.

If skiing or other sports are practised at a competitive level, professionals usually have athletic trainers at their disposal who follow them on a daily basis and who, with a series of tests, assisted by the orthopaedist/physiatrist specialist, can assess suitability for resuming sporting activity.

For those who practice skiing or other sports at an amateur level, on the other hand, the advice is not to force the time of return, but rather to rely on professional specialists who can arrange a rehabilitation programme to be followed in the months following surgery.