Skiing is an exhilarating sport that challenges balance, agility, and strength. However, with high-speed descents and unpredictable terrain, injuries are a common risk—especially to the knees. One of the most frequent and serious skiing injuries is an anterior cruciate ligament (ACL) tear. (It is also a common injury in twisting and impact sports such as football, netball and basketball.)
What is the ACL and Why is it Important?
The ACL is a crucial ligament in the knee that keeps the knee stable when twisting and changing direction. Its primary role is to prevent excessive forward movement (anterior translation) of the tibia relative to the femur. In other words, it helps stabilize the knee during movement.
How Do ACL Injuries Happen in Skiing?
ACL tears can occur from direct contact (e.g., colliding with another skier) or non-contact mechanisms such as sudden twisting motions. Common skiing-related causes include:
Catching an edge, causing the knee to twist awkwardly
Failure of your skis to release when you twist or fall
Landing poorly from a jump
Losing balance while shifting weight between skis
Sudden deceleration or stopping, putting excessive strain on the knee joint
What happens when you tear your ACL?
When you injure your ACL, you may experience these symptoms:
Sudden pain within the knee joint at the time of injury
Swelling that develops within 24 hours of injury
Loss of full knee range of motion (difficulty bending or straightening the knee)
Tenderness around the joint line
Discomfort when walking
A sensation of instability, or the knee giving way, particularly with full ACL ruptures
Grading ACL Injuries
ACL injuries are classified into three grades:
Grade 1: Mild damage with a few ligament fibers injured but still intact. Minimal instability.
Grade 2: Partial tear, with a greater number of fibres damaged. Increased knee instability.
Grade 3: Complete rupture of the ACL, leading to significant knee instability.
Diagnosing an ACL Injury
A physiotherapist or doctor will begin by taking a detailed history of how the injury occurred, including specific movements that aggravated the knee. Clinical tests such as Lachman’s test and the anterior drawer test assess ligament integrity and end feel. If a full rupture is suspected, an MRI may be recommended to confirm the severity and identify any associated injuries (e.g. meniscus or cartilage damage).
Rehabilitation and Recovery
The timeline for ACL recovery depends on the severity of the injury:
Grade 1 sprains: Typically heal within 2-4 weeks with rehabilitation focused on restoring strength and stability.
Grade 2 sprains: Require 6-8 weeks of structured rehab.
Grade 3 ruptures: Often necessitate surgery, with a recovery timeline of 9-12 months. Post-operative rehabilitation follows structured protocols such as the Melbourne ACL Rehabilitation Guide (link).
Final Thoughts
ACL injuries are a serious setback for skiers, but with the right management, recovery is achievable. Prevention strategies such as strength training, proper technique, and wearing well-fitted ski equipment can help reduce the risk. If you experience knee pain or instability after a skiing incident, seek professional assessment early to optimise your recovery.
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