Risk factors of Anterior Crucial Ligament injuries in alpine skiing. A review of the literature

Anterior cruciate ligament (ACL) injuries are the most frequently occurring knee injuries in alpine skiing and represent a significant challenge for both professional athletes and recreational participants.Women with their combination of biomechanical and hormonal risks, as well as novice skiers with their skill-related influences, are particularly vulnerable to ACL injury.These injuries account for 15-21% of all knee traumas in the sport, often stemming from noncontact mechanisms like twisting falls or improper weight distribution during dynamic maneuvers.The injury risk can be amplified by the interaction between intrinsic factors, such as sex, age, anatomical characteristics, neuromuscular imbalances, and extrinsic elements, including equipment setup and environmental conditions.Females exhibit a threefold higher risk than males, influenced by hormonal and biomechanical differences, while side-to-side knee laxity and neuromuscular asymmetries heighten susceptibility in competitive athletes.Equipment, mainly worn ski boot soles or misadjusted bindings, contributes to accidents by compromising ski-boot-binding functionality.Preventative strategies targeting neuromuscular training, proper equipment maintenance, and education about environmental adaptations show promise in mitigating the risk of injury due to environmental factors like icy or grippy snow and cold temperatures.However, reinjury remains a concern, especially for adolescents returning to sport within two years post-ACL reconstruction.Through reviewing 28 studies, this paper creates an overview of the multifactorial cause of ACL injuries in skiing to indicate the need for individually tailored prevention strategies and to stimulate further research regarding risk-reducing interventions in skiing.