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In recent years, more and more articles in the literature have documented female athletic injuries, especially knee injuries and, in particular, injuries to the anterior cruciate ligament. It has become obvious that this injury is a particularly serious one. A number of explanations have been given for this increased incidence. One obvious difference in recent years has been the more aggressive approach to athletics by the female participant.
To see whether female alpine ski racers were having a greater percentage of anterior cruciate ligament injuries, a study was developed in conjunction with the Vermont Alpine Racing Association (VARA). A questionnaire was sent to all VARA alpine racers during the summer of 1985, asking for information about ski injuries, training, mechanism of injuries, and treatment. The questionnaire included a release from the skier for information from treating physicians. In addition, coaches were sent printouts of responses, so that further responses and information could be obtained.
Out of approximately 600 racers, 196 Vermont alpine ski racers responded to the questionnaire. Of these, 135 respondees were male and 61 were female. Thirty-three male racers (twenty-five percent) reported knee injuries, but only four (three percent) reported cruciate ligament injuries. This correlated fairly closely with the percentages that have been reported for male basketball players. Twenty-three female racers (thirty-eight percent) reported knee injuries. This was not a remarkable difference from the male racers' percentage of knee injuries. Significantly, however, eleven (18%) of the females responding had cruciate ligament injuries, which was six times the incidence of their male counterparts. Almost one out of every five serious alpine female ski racers were reporting serious knee injuries that included anterior cruciate ligament tears!
This study has revealed a significantly higher incidence of serious knee injuries in female versus male ski racers. Because this fairly large group of skiers is well controlled as far as site of skiing (Vermont), level of expertise (all expert skiers), and equipment (essentially all have state-of-the art skis, bindings and boots), this observation appears to be significant. The most serious of the knee injuries is the anterior cruciate tear, and this was prevalent in females to males in a 6:1 ratio. Further study would seem to be merited to discover the cause of this difference, whether it be muscle strength, knee geometry, or equipment. Certainly, the concept of preventive bracing must be considered if this incidence of serious knee injuries continues or increases.
anterior cruciate ligament, injury, knee, skiing, surgical repair, female, alpine
United States Ski Team Physician, Rutland, VT
Physiciancodirector, Rutland Regional Medical CenterKillington Mountain Clinic, RutlandKillington, VTVT