In recreational alpine skiing ACL injury risk depends on the interaction of individual characteristics and behaviours as well as on equipment-related factors.
to evaluate if and to what extent personal characteristics and equipment-related parameters are associated with ACL injury risk in cautious and risk-taking recreational alpine skiers.
A retrospective questionnaire-based, case-control study of ACL-injured and uninjured in a cohort of cautious as well as risk-taking recreational skiers was conducted. Participants self-reported their demographics, skiing skill level, and risk-taking behaviour. Ski length, side-cut radius, widths of the tip, waist, and tail were recorded from each participant's skis. Standing heights at the front and rear components of the ski binding were measured with a digital sliding caliper, and a standing height ratio between the front and rear components was calculated. Ski boot sole abrasion at the toe and heel pieces was also measured with the digital sliding caliper.
In total, 1068 recreational skiers (50.8% females) with a mean age of 37.8 ± 12.3 years participated, of whom 193 (22.0%) sustained an ACL injury, and 330 (30.9%) participants reported a risk-taking behaviour. Results of the multiple logistic regression analyses revealed that a higher age, a lower skill level, a higher standing height ratio, and greater ski boot sole abrasion at the toe as well as heel pieces were independently associated with an increased ACL injury risk in both the cautious and the risk-taking group. Among cautious skiers, a longer ski length was an additional significant risk factor for sustaining an ACL injury. In conclusion, the same personal and equipment related characteristics contribute to an increase in the ACL injury risk regardless of risk-taking behaviour, with the only difference that longer skis represent an additional risk factor in cautious skiers.
Citation: Gerhard Ruedl, Markus Posch, Elena Pocecco, Katja Tecklenburg, Birgit Schliernzauer, Michael D. Kennedy, Martin Faulhaber, Martin Burtscher. Association of personal and equipment-related factors on ACL injury risk in alpine skiers with cautious or risk-taking behaviour: A case-control study[J]. AIMS Public Health, 2023, 10(2): 348-359. doi: 10.3934/publichealth.2023026
In recreational alpine skiing ACL injury risk depends on the interaction of individual characteristics and behaviours as well as on equipment-related factors.
to evaluate if and to what extent personal characteristics and equipment-related parameters are associated with ACL injury risk in cautious and risk-taking recreational alpine skiers.
A retrospective questionnaire-based, case-control study of ACL-injured and uninjured in a cohort of cautious as well as risk-taking recreational skiers was conducted. Participants self-reported their demographics, skiing skill level, and risk-taking behaviour. Ski length, side-cut radius, widths of the tip, waist, and tail were recorded from each participant's skis. Standing heights at the front and rear components of the ski binding were measured with a digital sliding caliper, and a standing height ratio between the front and rear components was calculated. Ski boot sole abrasion at the toe and heel pieces was also measured with the digital sliding caliper.
In total, 1068 recreational skiers (50.8% females) with a mean age of 37.8 ± 12.3 years participated, of whom 193 (22.0%) sustained an ACL injury, and 330 (30.9%) participants reported a risk-taking behaviour. Results of the multiple logistic regression analyses revealed that a higher age, a lower skill level, a higher standing height ratio, and greater ski boot sole abrasion at the toe as well as heel pieces were independently associated with an increased ACL injury risk in both the cautious and the risk-taking group. Among cautious skiers, a longer ski length was an additional significant risk factor for sustaining an ACL injury. In conclusion, the same personal and equipment related characteristics contribute to an increase in the ACL injury risk regardless of risk-taking behaviour, with the only difference that longer skis represent an additional risk factor in cautious skiers.
[1] | Kim S, Endres NK, Johnson RJ, et al. (2012) Snowboarding injuries: trends over time and comparisons with alpine skiing injuries. Am J Sports Med 40: 770-776. https://doi.org/10.1177/0363546511433279 |
[2] | LaPorte JD, Bajolle L, Lamy D, et al. (2012) Winter sport injuries in France over two decades. Skiing Trauma and Safety.ASTM International 201-215. https://doi.org/10.1520/STP20120055 |
[3] | Majewski M, Habelt S, Steinbrück K (2006) Epidemiology of athletic knee injuries: a 10-year study. Knee 13: 184-188. https://doi.org/10.1016/j.knee.2006.01.005 |
[4] | Posch M, Schranz A, Lener M, et al. (2021) In recreational alpine skiing, the ACL is predominantly injured in all knee injuries needing hospitalisation. Knee Surg Sport Tr A 29: 1790-1796. https://doi.org/10.1007/s00167-020-06221-z |
[5] | Bahr R, Krosshaug T (2005) Understanding injury mechanisms: a key component of preventing injuries in sport. Br J Sports Med 39: 324-329. https://doi.org/10.1136/bjsm.2005.018341 |
[6] | Hagel BE, Pless IB, Goulet C, et al. (2005) The effect of helmet use on injury severity and crash circumstances in skiers and snowboarders. Accid Anal Prev 37: 103-108. https://doi.org/10.1016/j.aap.2004.04.003 |
[7] | Scott MD, Buller DB, Andersen PA, et al. (2007) Testing the risk compensation hypothesis for safety helmets in alpine skiing and snowboarding. Inj Prev 13: 173-177. https://doi.org/10.1136/ip.2006.014142 |
[8] | Sulheim S, Holme I, Ekeland A, et al. (2006) Helmet use and risk of head injuries in alpine skiers and snowboarders. JAMA 296: 919-924. https://doi.org/10.1001/jama.295.8.919 |
[9] | Bianchi G, Brügger O, Niemann S, et al. (2011) Helmet use and self-reported risk taking in skiing and snowboarding. J ASTM Int 18: 32-43. https://doi.org/10.1520/STP49261S |
[10] | Ruzic L, Tudor A (2011) Risk-taking behavior in skiing among helmet wearers and nonwearers. Wild Environ Med 22: 291-296. https://doi.org/10.1016/j.wem.2011.09.001 |
[11] | Thomson CJ, Carlson SR (2015) Increased patterns of risky behaviours among helmet wearers in skiing and snowboarding. Accid Anal Prev 75: 179-183. https://doi.org/10.1016/j.aap.2014.11.024 |
[12] | Ruedl G, Pocecco E, Sommersacher R, et al. (2010) Factors associated with self reported risk taking behaviour on ski slopes. Br J Sports Med 44: 204-206. https://doi.org/10.1136/bjsm.2009.066779 |
[13] | Ruedl G, Abart M, Ledochowski L, et al. (2012) Self reported risk taking and risk compensation in skiers and snowboarders are associated with sensation seeking. Acc Anal Prev 48: 292-296. https://doi.org/10.1016/j.aap.2012.01.031 |
[14] | Ruedl G, Kopp M, Burtscher M (2012) Does risk compensation undo the protection of ski helmet use?. Epidemiology 23: 936-937. https://doi.org/10.1097/EDE.0b013e31826d2403 |
[15] | Bouter LM, Knipschild PG, Feij JA, et al. (1988) Sensation seeking and injury risk in downhill skiing. Pers Indiv Differ 9: 667-673. https://doi.org/10.1016/0191-8869(88)90164-X |
[16] | Goulet C, Regnier G, Valois P, et al. (2000) Injuries and risk taking in alpine skiing. Skiing Trauma and Safety.ASTM International 139-148. https://doi.org/10.1520/STP12872S |
[17] | Ruedl G, Burtscher M, Wolf M, et al. (2015) Are self-reported risk-taking behaviour and helmet use associated with injury causes among skiers and snowboarders?. Scan J Med Sci Sports 25: 125-130. https://doi.org/10.1111/sms.12139 |
[18] | Niedermeier M, Ruedl G, Burtscher M, et al. (2019) Injury-related behavioral variables in alpine skiers, snowboarders and ski tourers – a matched and enlarged re-analysis. Int J Environ Res Public Health 16: 3807. https://doi.org/10.3390/ijerph16203807 |
[19] | Ruedl G, Posch M, Niedermeier M, et al. (2019) Are risk taking and ski helmet use associated with an ACL injury in recreational alpine skiing?. Int J Environ Res Public Health 16: 3107. https://doi.org/10.3390/ijerph16173107 |
[20] | Spörri J, Kröll J, Gilgien M, et al. (2016) Sidecut radius and the mechanics of turning-equipment designed to reduce risk of severe traumatic knee injuries in alpine giant slalom ski racing. Br J Sports Med 50: 14-19. https://doi.org/10.1136/bjsports-2015-095737 |
[21] | Posch M, Ruedl G, Schranz A, et al. (2019) Is ski boot sole abrasion a potential ACL injury risk factor for male and female recreational skiers?. Scand J Med Sci Sports 29: 736-741. https://doi.org/10.1111/sms.13391 |
[22] | Ruedl G, Posch M, Tecklenburg K, et al. (2022) Impact of ski geometry data and standing height ratio on the ACL injury risk and its use for prevention in recreational skiers. Br J Sports Med . https://doi.org/10.1136/bjsports-2021-105221 |
[23] | Sulheim S, Ekeland A, Bahr R (2007) Self-estimation of ability among skiers and snowboarders in alpine skiing resorts. Knee Surg Sport Tr A 15: 665-670. https://doi.org/10.1007/s00167-006-0122-x |
[24] | Zuckerman M, Eysenck SB, Eysenck HJ (1978) Sensation seeking in England and America: Cross-cultural, age, and sex comparisons. J Consult Clin Psychol 46: 139-149. https://doi.org/10.1037//0022-006X.46.1.139 |
[25] | Burtscher M, Sommersacher R, Ruedl G, et al. (2009) Potential risk factors for knee injuries in alpine skiers. Skiing Trauma and Safety.ASTM International 1-4. https://doi.org/10.1520/JAI101378 |
[26] | McCarthy MM, Hannafin JA (2014) The mature athlete: aging tendon and ligament. Sports Health 6: 41-48. https://doi.org/10.1177/1941738113485691 |
[27] | McLeod M, Breen L, Hamilton DL, et al. (2016) Live strong and prosper: the importance of skeletal muscle strength for healthy ageing. Biogerontology 17: 497-510. https://doi.org/10.1007/s10522-015-9631-7 |
[28] | Hagel B (2005) Skiing and snowboarding injuries. Med Sport Sci 48: 74-119. https://doi.org/10.1159/000084284 |
[29] | Sulheim S, Holme I, Rødven A, et al. (2011) Risk factors for injuries in alpine skiing, telemark skiing and snowboarding – case-control study. Br J Sports Med 45: 1303-1309. https://doi.org/10.1136/bjsports-2011-090407 |
[30] | Wilson SA, Dahl KD, Dunford KM, et al. (2021) Ski boot canting adjustments affect kinematic, kinetic, and postural control measures associated with fall and injury risk. J Sci Med Sport 24: 1015-1020. https://doi.org/10.1016/j.jsams.2020.05.009 |
[31] | Wascher DC, Markolf KL, Shapiro MS, et al. (1993) Direct in vitro measurement of forces in the cruciate ligaments: Part I: The effect of multiplane loading in the intact knee. J Bone Joint Surg Am 75: 377-386. https://doi.org/10.2106/00004623-199303000-00009 |
[32] | Böhm H, Senner V (2008) Effect of ski boot settings on tibio-femoral abduction and rotation during standing and simulated skiing. J Biomech 41: 498-505. https://doi.org/10.1016/j.jbiomech.2007.10.019 |
[33] | Costa-Scorse B, Hopkins WG, Cronin J, et al. (2017) The utility of two national injury databases to evaluate snow-sports injuries in New Zealand. Snow Sports Trauma and Safety.Springer Nature 41-49. https://doi.org/10.1007/978-3-319-52755-0_4 |
[34] | Brener ND, Billy JOG, Grady WR (2003) Assessment of factors affecting the validity of self-reported health-risk behavior among adolescents: evidence from the scientific literature. J Adolesc Health 33: 436-457. https://doi.org/10.1016/S1054-139X(03)00052-1 |
[35] | Jack SJ, Ronan KR (1998) Sensation seeking among high- and low-risk sports participants. Pers Individ Dif 25: 1063-1083. https://doi.org/10.1016/S0191-8869(98)00081-6 |
[36] | Zuckerman M (2007) Sensation seeking and risky behavior. Washington: American Psychological Association. https://doi.org/10.1037/11555-000 |