Between December 1972 and April 1994 the authors evaluated prospectively 8023 injuries reported to the injury clinic operated in the base lodge of a moderate size northern Vermont ski area. During that time, approximately 2 480 000 skier-visits occurred at the area. This study is the most recent update of reports documenting long-term trends that have been presented at approximately four-year intervals. Although the overall injury rate decreased by 44% during the 22-year study, most of this decline occurred during the first ten years. Fractures and sprains to the lower leg, however, continued the improvement noted in previous reports with an 87% reduction. Although the incidence of knee ligament injuries did not change significantly, severe knee sprains, usually involving the anterior cruciate ligament, increased very significantly (228%), continuing a trend that began in the late 1970s. In general, the incidence of upper body injuries did not change although upper body lacerations and thumb ulnar collateral ligament sprains improved by 65 and 61%, respectively, while clavicular and trunk fractures, though rare, increased in incidence 234 and 202%, respectively.