A model for potential non-contact ski injuries of the knee

Abstract

Broadly accepted is that most knee injuries result from increased vertical forces, usually induced by an incidental ski fall, collision, or a high jump. We present a new non-contact knee injury mechanism that can happen during a ski turn. Such an injury is governed by a sudden inward turn of the inner ski and consequent swing of the inner leg followed by a nearly instant stop when locked by hip and knee joints. The model provides predictive results for a lateral tibial plateau compression fracture because several simplifications have been made. We confirmed that the modelled compression stresses at typical skiing conditions and with typical skiing equipment can provoke serious knee injuries. The awareness of skiers and skiing equipment industry of the described knee injury mechanism can act as an important injury-prevention factor.

Keywords

Non-contact injury / Knee / Biomechanical model / Compression fracture / Lateral tibial plateau

Authors’ contributions

Concept and initial model: TR; data acquisition and medical aspects: VM; injury model: KG; drafting manuscript: TR; revisions and comments: KG, VM, TR; final approval of manuscript: KG, VM, TR.

Funding and acknowledgement

The study was financially supported by the state budget of the Slovenian Research Agency under grant P2-0095. The authors would like to acknowledge international ski instructors Iztok Belehar and Janez Polajnar for valuable discussions on the professional and recreational skiing techniques.

Ethical approval

The study procedures were approved by the institutional review board for research involving human subjects of the University Medical Centre Ljubljana and complied with the Helsinki Declaration. All volunteers signed a written informed consent prior to participating in the study.

Conflict of interest

All authors confirm that no potential conflicts of interest are to be declared.

References

[1] R.J. Johnson, C.F. Ettlinger, J.E. Shealy. Update on injury trends in alpine skiing. R.J. Johnson, J.E. Shealy, M. Langren (Eds.), Skiing Trauma and Safety: 17^th Volume, ASTM STP 1510, Philadelphia ( 2009), pp. 11-22, DOI: 10.1520/STP1510-EB

[2] A. Ekeland, A. Rødven, S. Heir. Injury trends in recreational skiers and boarders in the 16-year period 1996-2012. I. Scher, R. Greenwald, N. Petrone (Eds.), Proceeding of International Society for Skiing Safety:21^st Volume. Snow Sports Trauma and Safety, Springer, Cham ( 2017), pp. 3-16, DOI: 10.1007/978-3-319-52755-0

[3] E. Shiotani, S. Kuriyama, R. Amemiya, K. Inagaki. Recent trends in ski-related injuries. Showa Univ J Med Sci, 30 ( 2018), pp. 113-122, DOI: 10.15369/sujms.30.113

[4] A. Davey, N.K. Endres, R.J. Johnson, J.E. Shealy. Alpine skiing injuries. Sport Health, 11 ( 2019), pp. 18-26, DOI: 10.1177/1941738118813051

[5] V. Senner, F. Michel, S. Lehner, O. Brugger. Technical possibilities for optimising the ski-binding-boot functional unit to reduce knee injuries in recreational alpine skiing. Sports Eng, 16 ( 2013), pp. 211-228, DOI: 10.1007/s12283-013-0138-7

[6] J.E. Shealy, C.F. Ettlinger, R.J. Johnson. How fast do winter sports participants travel on alpine slopes?. J ASTM Int (JAI), 2 ( 2005), pp. 1-8, DOI: 10.1520/JAI12092

[7] M. Burtscher, H. Gatterer, M. Flatz, et al.. Effects of modern ski equipment on the overall injury rate and the pattern of injury location in alpine skiing. Clin J Sport Med, 18 ( 2008), pp. 355-357, DOI: 10.1097/MJT.0b013e31815fd0fe

[8] R. Hunter. Skiing injuries. Am J Sports Med, 27 ( 1999), pp. 381-389, DOI: 10.1177/03635465990270032101

[9] J. Kennedy, W. Bailey. Experimental tibial-plateau fractures: studies of the mechanism and a classification. J Bone Joint Surg Am, 50 ( 1968), pp. 1522-1534. PMID: 5722848

[10] J. McConkey, W. Meeuwisse. Tibial plateau fractures in alpine skiing. Am J Sports Med, 16 ( 1988), pp. 159-164, DOI: 10.1177/036354658801600212

[11] M. Klous, E. Müller, H. Schwameder. Three-dimensional knee joint loading in alpine skiing: a comparison between a carved and a skidded turn. J Appl Biomech, 28 ( 2012), pp. 655-664, DOI: 10.1123/jab.28.6.655

[12] N.H. Hart, S. Nimphius, T. Rantalainen, A. Ireland, A. Siafarikas, R.U. Newton. Mechanical basis of bone strength: influence of bone material, bone structure and muscle action. J Musculoskel Neuron, 17 (3) ( 2017), pp. 114-139. PMID: 28860414

[13] R. Trobec, I. Belehar, J. Polajnar, M. Veselko.Ski injury triggers of tibial plateau compression fracture. Proceedings of 36th International Convention MIPRO. Croatia, Opatija ( 2013), pp. 360-364. org/document/6596282

[14] M. Veselko,J. Polajnar. New skiing techniques - new injuries? Analysis of ski injuries in 2004/2005. Zdr Vestn, 77 ( 2008), pp. 499-504.

[15] C.-F. Lin, H. Liu, M.T. Gros, P. Weinhold, W.E. Garrett, B. Yu. Biomechanical risk factors of non-contact ACL injuries: a stochastic biomechanical modelling study. J Sport Health Sci, 1 ( 2012), pp. 36-42, DOI: 10.1016/j.jshs.2012.01.001

[16] L. Bisson, M. Kluczynski, L. Hagstrom, J. Marzo. A prospective study of the association between bone contusion and intra-articular injuries associated with acute anterior cruciate ligament tear. Am J Sports Med, 41 ( 2013), pp. 1801-1807, DOI: 10.1177/0363546513490649

[17] L. Durselen, L. Claes, H. Kiefer. The influence of muscle forces and external loads on cruciate ligament strain. Am J Sports Med, 23 ( 1995), pp. 129-136, DOI: 10.1177/036354659502300122

[18] A.D. Bankoff. Biomechanical characteristics of the bone. T. Goswami ( Ed.), Human Musculoskel Biomech, IntechOpen ( 2012), pp. 61-86, DOI: 10.5772/19690

[19] B. Nigg, W. Herzog. Biomechanics of the Musculo-Skeletal System. 978-0-470-01767-8, Wiley ( 2007)

[20] R. Bahr, T. Krosshaug. Understanding injury mechanisms: a key component of preventing injuries in sport. Br J Sports Med, 39 ( 2005), pp. 324-329, DOI: 10.1136/bjsm.2005.018341

[21] M.S. Koehle, R. Lloyd-Smith, J.E. Taunton. Alpine ski injuries and their prevention. Sports Med, 32 ( 2002), pp. 785-793, DOI: 10.2165/00007256-200232120-00003

[22] C. Senter, S. Hame. Biomechanical analysis of tibial torque and knee flexion angle: implications for understanding knee injury. Sports Med, 36 ( 2006), pp. 635-641, DOI: 10.2165/00007256-200636080-00001

[23] G. Ruedl, I. Linortner, A. Schranz. Distribution of injury mechanisms and related factors in ACL-injured female carving skiers. Knee Surg Sports Traumatol Arthrosc, 17 ( 2009), pp. 1393-1398, DOI: 10.1007/s00167-009-0860-7

[24] T. Bere, T.W. Flørenes, T. Krosshaug, et al.. Mechanisms of anterior cruciate ligament injury in World Cup alpine skiing: a systematic video analysis of 20 cases. Am J Sports Med, 39 ( 2011), pp. 1421-1429, DOI: 10.1177/0363546511405147

[25] M. Cornwall. Biomechanics of noncontractile tissue: a review. Phys Ther, 64 ( 1984), pp. 1869-1873, DOI: 10.1093/ptj/64.12.1869