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The number of ligament injuries at skiing remains very high. Despite improvements in ski safety equipment made in recent years, research and development is needed to work toward an effective breakthrough in preventing injuries. Knee surgeons together with biomechanical engineers have to research and to establish comprehensive specifications about the so-called “critical load cases,” with which future ski safety equipment will have to comply. We reviewed the current literature and analyzed the published injury mechanisms in order to check their plausibility regarding the related skiing maneuvers described. Derived from literature analysis and our own studies, we describe a new critical load case, the so-called “transition maneuver.” The sliding upper body undergoes a transition from the uphill side over the ski tails to the downhill side, leading to a geometrically enforced anterior tibial translation. We discuss published video sequences of injured skiers in respect to the probable maneuvers and the derived potential injury mechanism. We differentiate further between two main maneuvers where a ski rotates against the skier's inertia and where a skier rotates against his skis held in their track. An attempt is made to group the various maneuvers systematically into load cases, which can be considered critical for the knee ligaments. The four basic groups (flexion, external rotation, internal rotation, and extension) are split into a total number of 17 subgroups (i.e., load cases), with each of them comprising one or more distinctive (skiing) maneuvers. An overview of these “critical load cases” is presented in a table, which may be used as a check list for future classification of knee ligament injuries at skiing.
knee ligaments, ACL, MCL, critical load cases, injury mechanism, skiing maneuvers, falling maneuvers
Diplomiester Maschineningeniur ETH, Ingenieurbüro Flugwesen und Biomechanik IFB AG, Bremgarten,
Head, Kantonsspital, Bruderholz/Basel,