Understanding ACL Tears in Skiing: Causes and Solutions

The ACL: The Skier’s Most Injured Ligament

Skiing is an incredible way to enjoy the winter months — fresh air, speed, and freedom on the slopes. But even for recreational skiers, one of the biggest risks remains a knee injury, particularly a tear of the anterior cruciate ligament (ACL).

Research from the University of Innsbruck shows that ACL injuries account for nearly all serious knee injuries in skiing, often accompanied by other ligament or meniscus damage. In fact, around 1 in 5 ski-related hospital visits involve the ACL.

So, why does this happen — and more importantly, what can you do to protect your knees before your next trip?

Why ACL Injuries Are So Common in Skiing

Recent studies (Posch et al., 2020; Ruedl et al., 2023) reveal that most ACL injuries in skiing occur without a collision. Instead, they happen during falls or awkward twists — for example, when a ski edge catches the snow or the skier tries to recover from losing balance.

These injuries often involve a “forward twisting fall” that places high rotational stress on the knee, leading to ACL rupture.
The problem isn’t just bad luck — it’s also linked to:

• Lack of preseason conditioning
• Poor ski control from fatigue
• Worn or poorly adjusted equipment (especially boots and bindings)
• Overly long skis or high binding setups
• Lower skill level or riskier behaviour on steep terrain

Equipment-Related Risk Factors: What the Latest Research Says

A 2023 study published in The Orthopaedic Journal of Sports Medicine examined over 1,800 recreational skiers and identified several equipment-based ACL risk factors:

1. Standing Height Ratio – When the rear binding sits too high compared to the front, the risk of ACL injury increases.
2. Boot Sole Wear – Worn boot soles can prevent bindings from releasing properly, increasing injury risk by up to 3 times.
3. Ski Length – For less experienced female skiers, longer skis significantly raise ACL injury risk.
4. Rented or Borrowed Equipment – Using unfamiliar or poorly adjusted skis is a common factor in ACL tears.

Takeaway: The condition and setup of your equipment matter.

Skill, Gender, and Behaviour — Other Key Factors

• Female skiers have a three times higher risk of ACL tears than males, due to anatomical and hormonal factors.
• Lower skill level is strongly associated with higher injury risk.
• Among men, risk-taking behaviour (higher speeds, aggressive turns) further increases ACL injury rates.

This means risk mitigation strategies must be individualized — focusing on strength, balance, and proper technique before hitting the slopes.

How to Prevent ACL Injuries Before Your Ski Trip

A key part of ACL injury prevention starts well before you get to the mountain. Pre-season ski conditioning improves the very qualities that protect your knees — strength, balance, coordination, and endurance. As explained in our related post, Physiotherapy Insights for Staying Strong, Confident, and Injury-Free This Ski Season the right preparation can significantly reduce fatigue and injury risk by training your body for the demands of skiing.

Focusing on eccentric and isometric strength training helps the muscles absorb impact and stabilise the knee joint during turns and landings, while core and balance exercises enhance control on uneven terrain. Incorporating neuromuscular and plyometric drills improves reaction time and joint alignment, both critical in preventing sudden twisting movements that strain the ACL. Ideally, begin conditioning 6–8 weeks before your ski trip, combining strength, mobility, and endurance work.

Here are evidence-based steps to reduce your risk — many of which can be guided by your physiotherapist before the ski season starts.

1. Prepare Your Body

Start your ski conditioning at least 6–8 weeks before your trip to allow time for neuromuscular adaptations.

2. Check Your Equipment

• Inspect boot soles and replace them if worn.
• Get your bindings professionally serviced to ensure correct release settings.
• Choose ski length and stiffness appropriate for your height, weight, and skill level.
• Avoid using borrowed or old equipment unless it has been safety-checked.

3. Learn Safer Fall Mechanics

• Avoiding the instinct to fight a fall.
• Don’t try to hold your skis or fight them; let them go they are designed to release to help mitigate the risk.
• Avoid using your hands to break the fall.

4. Manage Fatigue and Terrain Choices

Most ski injuries occur at the end of the day when fatigue sets in. Take breaks, stay hydrated, and stick to runs suited to your ability — especially in poor visibility or icy conditions.

Preparing for the Ski Season: The Role of Physiotherapy

At our physiotherapy practice, we work with skiers to help them:

• Build strong, stable knees before ski season
• Recover safely after past knee or ACL injuries
• Learn individualized prevention exercises to reduce reinjury risk

Whether you’re preparing for your first trip or returning after injury, a Pre Ski Assessment can make all the difference in keeping you strong, confident, and injury-free on the slopes. Call us at 0115 686 0288 or book online to prepare your knees for the slopes this winter.

References

Posch, M., Schranz, A., Lener, M., Tecklenburg, K., Burtscher, M. and Ruedl, G. (2020) In recreational alpine skiing, the ACL is predominantly injured in all knee injuries needing hospitalisation. Knee Surgery, Sports Traumatology, Arthroscopy, 29(6), pp. 1790–1796.
DOI: 10.1007/s00167-020-06221-z

Ruedl, G., Posch, M., Tecklenburg, K., Schranz, A., Faulhaber, M. and Burtscher, M. (2023) Skill-specific differences in equipment-related risk factors for ACL injury in male and female recreational skiers.Orthopaedic Journal of Sports Medicine, 11(3), 23259671231155841.
DOI: 10.1177/23259671231155841