ACL injuries in elite alpine skiing reliably allow athletes to return to competition and perform at or above their pre‐injury level

PURPOSE: Anterior cruciate ligament (ACL) injuries are frequently observed in alpine skiing. However, available data regarding post-injury performance levels remain scarce. This study aimed to investigate whether ACL injuries in elite-level alpine skiers limit performance levels after ACL reconstruction (ACLR). METHODS: Male and female elite-level alpine skiers from national A-teams who sustained an ACL injury were retrospectively identified through media reports and the Fédération Internationale de Ski database, across all disciplines (downhill, super G, giant slalom and slalom SL). World Cup (WC) results and time out of competition before injury and after ACLR were analyzed. Inclusion criteria were injury during or after the 2003/2004 season and participation in at least one WC event pre-injury. Performance levels from two seasons before the injury through the 2022/2023 season were assessed. RESULTS: Forty-eight elite alpine skiers (28 males and 20 females) met the inclusion criteria. Of these, 97.9% returned to professional competition after ACLR. One female athlete had not yet returned due to a recent injury. The mean return-to-competition (RTC) time was 11.9 ± 4.5 (range: 7-25) months for males and 11.3 ± 1.8 (8-16) months for females. Post-ACLR, athletes demonstrated similar or improved mean WC placements, regardless of discipline. A decline in performance was observed only in SL. A corresponding trend was observed in the top three placements following ACLR. Among skiers returning to competition, 80.8% of males and 63.1% of females reached their pre-injury performance levels. Athletes with multiple injuries or nonoperative treatment showed variable outcomes. CONCLUSION: Elite alpine skiers can successfully return to WC competition following ACL injury, with many reaching or surpassing pre-injury performance. Performance variability underscores the need for individualized therapy and rehabilitation to optimize recovery in this specific population. LEVEL OF EVIDENCE: Level IV.