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What do Skiing, Kids and ACLs Have in Common?

Some had dreams of a snow-blanketed mountain by Dec. 1, but it’s only a matter of time. Soon, folks from all walks of life will begin cruising down snow-covered slopes in our local mountain regions. Skiing offers recreation, leisure, exercise, connection and, for the more serious youth, competition. As an orthopedic surgeon specializing in sports medicine, a parent of young competitive skiers and a former ski racing competitor myself, I personally have seen both joy and pain on and off the slopes. Skiing is an incredible sport that can create laughter and smiles and bring medals to fast competitors. But as with all extreme sports, injuries do occur, from sprains and strains to broken bones. Skiing is not without its risks.

The most common injuries for skiers is an injury to the knee joint, of which the anterior cruciate ligament, or ACL, is a component. The ACL is a ligament located inside the knee joint that provides both stability and flexibility to the knee while allowing for fluid mechanics. It is one of the four main ligaments of the knee and is the major connector of the femur (thigh bone) and tibia (shin bone) that prevents forward translation of the tibia with relation to the femur. The most common causes of an ACL tear or injury is twisting the knee while falling backwards or landing on a hyper-extended knee. These mechanisms cause the lower leg to translate forward, leading to ligament tearing.

ACL injuries in skiers are particularly common because of the torque (twisting and turning) and force put on the knee joints. Stopping or changing directions (pivoting) suddenly, twisting of the knee, bending the knee sideways during a fall or through contact force, such as being hit from the front or side. Most people report hearing a “pop” when the ACL is severely injured or torn.


ACL injuries in Children

  • Kids’ high energy combined with a strong desire to be recognized and succeed, creates an injury risk scenario.
  • Teens tend to have more ACL injuries than younger children.
  • Kids 12 and under are more likely to break the bone near the ACL rather than tear the ligament.
  • Teenage girls are more likely to injure their ACL than boys. Differences in muscle strength, anatomy, coordination and body size most likely are responsible for this difference.


A child may still be able to walk with an injured ACL, but may feel wobbly or they may favor the knee. Usually within 24 hours, there is pain and swelling. For the less-obvious injuries, it will show when the child tries to do the sport or activity again.

When a child injures the knee, stop all activity to avoid further damage and make an immediate appointment with a physician. Next, ice the area of the knee for up to 20 minutes at a time every hour. Also, keep the knee elevated and slightly bent to help reduce swelling. Diagnosing the injury requires a physical exam and possibly an imaging test, such as an MRI. MRI images can reveal injury to the soft tissues like ligaments and muscles and can show if the ACL is injured.

Because younger individuals are still growing, growth plates at the ends of bones typically are still open. These open growth plates present an additional challenge when surgically repairing a torn ligament, such as the ACL. If surgery is required, the surgeon is careful to assess the growth plates and plan appropriately while repairing or reattaching the ligament. If reconstruction is in order, tissue from the patient’s own body is frequently used as the scaffold for new ligament healing and integration. Following surgery, a full-leg brace is worn for up to six weeks with the immediate initiation of physical therapy.

In many cases, non-surgical treatment options and rehabilitation are the best means to help a partially torn ligament heal. Physical therapy focuses on restoring and improving strength and stability in the injured joint and surrounding muscles while reestablishing balance and range of motion. PT can also bring a sense of self-confidence as the injured skier is able to see that he or she may be strong and well again. While many sports may be off-limits while the body is repairing itself, some low-impact activities, such as swimming and stationary cycling, could aid in the healing process.


Prevention is Key

There are several ways to help prevent ACL and other injuries:

  • Do strengthening exercises of the upper and lower body with attention paid to core strength – this is the No. 1 protection when it comes to any sport. Strength is your best friend.
  • Stretch before and after hitting the slopes (and during) if muscles feel tight. Hands down, as we age flexibility is the secret to injury avoidance.
  • Know your limits and abide by them.
  • Never relax when approaching the lift line or the bottom of a run. Most injuries occur either at the end of the day or the end of the run, simply because of the euphoria of believing you have completed your task when in reality, the run isn’t over until you have come to a complete stop.
  • Use the appropriate-sized and appropriate-aged gear.
  • Get all gear tuned up before the season and check all bindings – have a professional do this for you. FBN

By Yuri M. Lewicky, M.D. 

Dr. Yuri Lewicky is a fellowship-trained orthopaedic surgeon specializing in Sports Medicine at Northern Arizona Orthopaedics (NAO) inside the Summit Center. He has Subspecialty Certification in Sports Medicine. Dr. Lewicky frequently sees and treats injuries of the knee and shoulder in athletes and patients from all walks of life. To learn more about Dr. Lewicky and the NAO team of physicians, visit northazortho.com.



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