Biomechanics, Mechanisms, Prevention and Characteristics of Knee Injuries in Recreational and Sports Alpine Skiing: A Narrative Review
DOI:
https://doi.org/10.12775/QS.2026.53.69949Keywords
alpine skiing, knee injury, ACL injury, anterior cruciate ligament, MCL injury, meniscus injury, ski injury epidemiology, injury mechanism, return to sport, iinjury prevention in skiingAbstract
Background
Alpine skiing is a popular winter sport but is associated with a considerable risk of musculoskeletal injuries. Among them, knee injuries are the most frequent and clinically significant, particularly ruptures of the anterior cruciate ligament (ACL). The combination of high skiing speed, rotational forces, and interaction with modern ski equipment contributes to complex mechanisms leading to knee joint trauma in both recreational and competitive skiers.
Aim
The aim of this study was to review current knowledge on the biomechanics, mechanisms, characteristics, and prevention of knee injuries in alpine skiing.
Material and methods
A literature review was conducted using the following databases: PubMed, Scopus, and Web of Science. The review included publications published between 2000 and 2025. The following keywords and their combinations were used with Boolean operators: “alpine skiing”, “knee injury”, “ACL injury”, “anterior cruciate ligament”, “MCL injury”, “meniscus injury”, “ski injury epidemiology”, “injury mechanism”, “return to sport”, and “injury prevention in skiing”..
Results
The knee joint accounts for approximately one-third of all alpine skiing injuries, with ACL rupture being the most common severe injury. Most cases occur through non-contact mechanisms such as slip-catch, phantom foot, dynamic snowplow, and landing back-weighted. These mechanisms involve valgus loading, tibial rotation, and anterior tibial translation. Major risk factors include high speed, fatigue, neuromuscular deficits, equipment characteristics, and environmental conditions.
Conclusions
Knee injuries in alpine skiing result from complex interactions between biomechanical forces, skiing technique, and equipment. Understanding these mechanisms is essential for prevention. Targeted neuromuscular training, skier education, and proper equipment adjustment may help reduce injury incidence and improve safety.
References
1. Cusimano, M.D., Kwok, J.: The effectiveness of helmet wear in skiers and snowboarders: a systematic review. Br. J. Sports Med. 44, 781–786 (2010). https://doi.org/10.1136/bjsm.2009.070573
2. Posch, M., Schranz, A., Lener, M., Tecklenburg, K., Burtscher, M., Ruedl, G.: In recreational alpine skiing, the ACL is predominantly injured in all knee injuries needing hospitalisation. Knee Surg. Sports Traumatol. Arthrosc. 29, 1790–1796 (2021). https://doi.org/10.1007/s00167-020-06221-z
3. M, B., H, G., M, F., R, S., T, W., G, R., B, H., A, L., W, N.: Effects of modern ski equipment on the overall injury rate and the pattern of injury location in Alpine skiing. Clin. J. Sport Med. 18, 345–350 (2008). https://doi.org/10.1097/mjt.0b013e31815fd0fe
4. Posch, M., Schranz, A., Lener, M., Tecklenburg, K., Burtscher, M., Ruedl, G.: In recreational alpine skiing, the ACL is predominantly injured in all knee injuries needing hospitalisation. Knee Surgery, Sports Traumatology, Arthroscopy. 29, 1790 (2020). https://doi.org/10.1007/s00167-020-06221-z
5. Davey, A., Endres, N.K., Johnson, R.J., Shealy, J.E.: Alpine Skiing Injuries. Sports Health. 11, 18–26 (2019). https://doi.org/10.1177/1941738118813051
6. Bere, T., Flørenes, T.W., Krosshaug, T., Koga, H., Nordsletten, L., Irving, C., Muller, E., Reid, R.C., Senner, V., Bahr, R.: Mechanisms of anterior cruciate ligament injury in World Cup alpine skiing: a systematic video analysis of 20 cases. Am. J. Sports Med. 39, 1421–1429 (2011). https://doi.org/10.1177/0363546511405147
7. Sundberg, A., Högberg, J., Tosarelli, F., Buckthorpe, M., Della Villa, F., Hägglund, M., Samuelsson, K., Hamrin Senorski, E.: Sport-Specific Injury Mechanisms and Situational Patterns of ACL Injuries: A Comprehensive Systematic Review. Sports Med. 55, 2489–2527 (2025). https://doi.org/10.1007/s40279-025-02271-w
8. Bere, T., Flørenes, T.W., Krosshaug, T., Haugen, P., Svandal, I., Nordsletten, L., Bahr, R.: A systematic video analysis of 69 injury cases in World Cup alpine skiing. Scand. J. Med. Sci. Sports. 24, 667–677 (2014). https://doi.org/10.1111/sms.12038
9. Tarka, M.C., Davey, A., Lonza, G.C., O’Brien, C.M., Delaney, J.P., Endres, N.K.: Alpine Ski Racing Injuries. Sports Health: A Multidisciplinary Approach. 11, 265–271 (2019). https://doi.org/10.1177/1941738119825842
10. Johnson, R.J., Pope, M.H., Ettlinger, C.: Ski injuries and equipment function. J. Sports Med. 2, 299–307 (1974). https://doi.org/10.1177/036354657400200601
11. Lohmander, L.S., Englund, P.M., Dahl, L.L., Roos, E.M.: The Long-term Consequence of Anterior Cruciate Ligament and Meniscus Injuries. Am. J. Sports Med. 35, 1756–1769 (2007). https://doi.org/10.1177/0363546507307396
12. Ettlinger, C.F., Johnson, R.J., Shealy, J.E.: A method to help reduce the risk of serious knee sprains incurred in alpine skiing. Am. J. Sports Med. 23, 531–537 (1995). https://doi.org/10.1177/036354659502300503
13. Johnson, R., Ettlinger, C., Shealy, J.: Update on injury trends in alpine skiing. (2008)
14. Haaland, B., Steenstrup, S.E., Bere, T., Bahr, R., Nordsletten, L.: Injury rate and injury patterns in FIS World Cup Alpine skiing (2006–2015): have the new ski regulations made an impact? Br. J. Sports Med. 50, 32–36 (2016). https://doi.org/10.1136/bjsports-2015-095467
15. Duncan, J.B., Hunter, R., Purnell, M., Freeman, J.: Meniscal Injuries Associated With Acute Anterior Cruciate Ligament Tears in Alpine Skiers. Am. J. Sports Med. 23, 170–172 (1995). https://doi.org/10.1177/036354659502300208
16. Pressman, A., Johnson, D.H.: A review of ski injuries resulting in combined injury to the anterior cruciate ligament and medial collateral ligaments. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 19, 194–202 (2003). https://doi.org/10.1053/jars.2003.50054
17. Flørenes, T.W., Bere, T., Nordsletten, L., Heir, S., Bahr, R.: Injuries among male and female World Cup alpine skiers. Br. J. Sports Med. 43, 973–978 (2009). https://doi.org/10.1136/bjsm.2009.068759
18. Haida, A., Coulmy, N., Dor, F., Antero-Jacquemin, J., Marc, A., Ledanois, T., Tourny, C., Rousseaux-Blanchi, M.P., Chambat, P., Sedeaud, A., Toussaint, J.F.: Return to Sport Among French Alpine Skiers After an Anterior Cruciate Ligament Rupture: Results From 1980 to 2013. Am. J. Sports Med. 44, 324–330 (2016). https://doi.org/10.1177/0363546515612764
19. Kröll, J., Spörri, J., Gilgien, M., Schwameder, H., Müller, E.: Effect of ski geometry on aggressive ski behaviour and visual aesthetics: equipment designed to reduce risk of severe traumatic knee injuries in alpine giant slalom ski racing. Br. J. Sports Med. 50, 20 (2015). https://doi.org/10.1136/bjsports-2015-095433
20. Shea, K.G., Archibald-Seiffer, N., Murdock, E., Grimm, N.L., Jacobs, J.C., Willick, S., Van Houten, H.: Knee Injuries in Downhill Skiers: A 6-Year Survey Study. Orthop. J. Sports Med. 2, 2325967113519741 (2014). https://doi.org/10.1177/2325967113519741
21. Deady, L.H., Salonen, D.: Skiing and Snowboarding Injuries: A Review with a Focus on Mechanism of Injury. Radiol. Clin. North Am. 48, 1113–1124 (2010). https://doi.org/10.1016/j.rcl.2010.07.005
22. Oronowicz, J., Malinovskiy, V., Bumberger, A., Jasina, A., Lutter, C., Seil, R., Tischer, T.: ACL injuries in elite alpine skiing reliably allow athletes to return to competition and perform at or above their pre-injury level. Knee Surg. Sports Traumatol. Arthrosc. (2025). https://doi.org/10.1002/ksa.70090
23. Schmitt, K.U., Hörterer, N., Vogt, M., Frey, W.O., Lorenzetti, S.: Investigating physical fitness and race performance as determinants for the ACL injury risk in Alpine ski racing. BMC Sports Science, Medicine and Rehabilitation 2016 8:1. 8, 23- (2016). https://doi.org/10.1186/s13102-016-0049-6
24. Koga, H., Bere, T., Bahr, R., Krosshaug, T.: Kinematics of a slip-catch mechanism for anterior cruciate ligament injury in world cup alpine skiing. Br. J. Sports Med. 45, 327–327 (2011). https://doi.org/10.1136/bjsm.2011.084038.48
25. Tarka, M.C., Davey, A., Lonza, G.C., O’Brien, C.M., Delaney, J.P., Endres, N.K.: Alpine Ski Racing Injuries. Sports Health. 11, 265 (2019). https://doi.org/10.1177/1941738119825842
26. Jordan, M.J., Aagaard, P., Herzog, W.: Anterior cruciate ligament injury/reinjury in alpine ski racing: a narrative review. Open Access J. Sports Med. 8, 71–83 (2017). https://doi.org/10.2147/oajsm.s106699
27. Spörri, J., Kröll, J., Gilgien, M., Müller, E.: How to Prevent Injuries in Alpine Ski Racing: What Do We Know and Where Do We Go from Here? Sports Medicine 2016 47:4. 47, 599–614 (2016). https://doi.org/10.1007/s40279-016-0601-2
28. Csapo, R., Juras, V., Heinzle, B., Trattnig, S., Fink, C.: Compositional MRI of the anterior cruciate ligament of professional alpine ski racers: preliminary report on seasonal changes and load sensitivity. Eur. Radiol. Exp. 4, 64 (2020). https://doi.org/10.1186/s41747-020-00191-0
29. Hunter, R.E.: Skiing injuries. American Journal of Sports Medicine. 27, 381–388 (1999). https://doi.org/10.1177/03635465990270032101
30. Csapo, R., Hoser, C., Gföller, P., Raschner, C., Fink, C.: Fitness, knee function and competition performance in professional alpine skiers after ACL injury. J. Sci. Med. Sport. 22, S39–S43 (2019). https://doi.org/10.1016/j.jsams.2018.06.014
31. Pätzold, R., Spiegl, U., Wurster, M., Augat, P., Gutsfeld, P., Gonschorek, O., Bühren, V.: [Proximal tibial fractures sustained during alpine skiing - incidence and risk factors]. Sportverletz. Sportschaden. 27, 207–211 (2013). https://doi.org/10.1055/s-0033-1356108
32. Paletta, G.A., Warren, R.F.: Knee Injuries and Alpine Skiing: Treatment and Rehabilitation. Sports Medicine: Evaluations of Research in Exercise Science and Sports Medicine. 17, 411–423 (1994). https://doi.org/10.2165/00007256-199417060-00006
33. Stenroos, A., Pakarinen, H., Jalkanen, J., Mälkiä, T., Handolin, L.: Tibial Fractures in Alpine Skiing and Snowboarding in Finland: A Retrospective Study on Fracture Types and Injury Mechanisms in 363 Patients. Scand. J. Surg. 105, 191–196 (2016). https://doi.org/10.1177/1457496915607410
34. Vermont Ski Safety » Tips For Knee-Friendly Skiing » Vermont Ski Safety, https://vermontskisafety.com/research/tips/
35. Shi, H., Jiang, Y., Ren, S., Hu, X., Huang, H., Ao, Y.: Sex differences in the knee orthopaedic injury patterns among recreational alpine skiers. BMC Sports Science, Medicine and Rehabilitation 2020 12:1. 12, 74- (2020). https://doi.org/10.1186/s13102-020-00224-6
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Mikołaj Szczęsny, Małgorzata Katra, Marcin Ślot, Adrian Pal, Krzysztof Cienkowski, Patryk Cegiełka , Karolina Żeżawska , Izabella Głowacka , Aleksandra Adamczyk, Maria Sicińska
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Stats
Number of views and downloads: 72
Number of citations: 0
