ACL Injury Mechanisms and Related Factors in Male and Female Carving Skiers: A Retrospective Study

Abstract

In recreational alpine skiing, ACL injury risk is 3 times greater in females. However, since the introduction of carving skis ACL injury risk seems to have decreased. No study has yet investigated the distribution of ACL injury mechanisms in male and female carving skiers. Therefore, the aim of the study was to investigate potential gender specific differences of ACL injury mechanisms and related factors among carving skiers. In total, 220 recreational carving skiers (59 males and 161 females) suffering from an ACL injury volunteered for this study. Demographic data, skiing ability, equipment related and environmental factors, circumstances and causes for the fall, and type of fall (injury mechanisms) were collected by questionnaire. The forward twisting fall is the most reported ACL injury mechanism in both gender (p=0.672) accounting for 54% of all injuries, although male and female skiers differed significantly with regard to circumstances of fall (p=0.001) and actions when ACL injury occurred (p=0.04). Bindings not releasing at the time point of accident occurred 2.6 times more with females than with males (p=0.005). The forward twisting fall seems to have become the dominant ACL injury mechanism both in male and female recreational skiers since the introduction of carving skis.

Self-Release of Ski Bindings: A Sex Comparison

“…In our tests, 84% of female trials and 54% of male trials showed a failure of selfrelease of their ski bindings. These sex-specific values seem in line with findings observed among ACL-injured recreational skiers where 74-88% of female skiers compared to 55-67% male skiers reported a failure of binding to release [9][10][11][12]. This conformity might be somewhat surprising as the self-release test was performed in a stationary laboratory setting in contrast to the self-reported amount of failure of binding release during skiing on the slope leading to an ACL injury.…”

“…No increase in injuries from inadvertent binding release through reduced binding settings has been found [21]. However, these findings mean an association, and not definitely "cause and effect" relationship, because another study at the same time showed a decrease in ACL injury risk without reducing binding settings [22] which might be due to the introduction of the short and shaped carving skis at this time [11]. Interestingly, the ISO 11088 standard accepts a deviation of 15% between the measured release moment ("reference moment") determined according to the setting tables in ISO 8061 and ski binding settings may also be lowered by the same magnitude upon request of the skier [23].…”

“…This sex difference of knee injuries among recreational alpine skiers may be partly related to hormonal, anatomical, and/or neuromuscular risk factors which distinguish females from males [7,8]. Another decisive sex difference among knee-injured skiers concerns the amount of failure of binding to release at the moment of accident [9][10][11][12]. For instance, a total of 55-67% male skiers reported a failure of the ski bindings to release compared to 74-88% of female skiers suffering from an ACL injury [9][10][11][12].…”

“…Another decisive sex difference among knee-injured skiers concerns the amount of failure of binding to release at the moment of accident [9][10][11][12]. For instance, a total of 55-67% male skiers reported a failure of the ski bindings to release compared to 74-88% of female skiers suffering from an ACL injury [9][10][11][12]. This difference in binding non-releases percentages occurred even though there was no difference in the date of last binding adjustment [11], whether the bindings were adjusted correctly [13], or self-reported types of falling [11,12].…”

“…For instance, a total of 55-67% male skiers reported a failure of the ski bindings to release compared to 74-88% of female skiers suffering from an ACL injury [9][10][11][12]. This difference in binding non-releases percentages occurred even though there was no difference in the date of last binding adjustment [11], whether the bindings were adjusted correctly [13], or self-reported types of falling [11,12]. In a very recent study among a cohort of about 500 male and female recreational skiers suffering from an ACL injury, Ruedl et al [12] showed that binding release was independently associated with forward falling with rotation.…”