Participating in Alpine sports, like skiing and snowboarding, carries an inherent risk of injury. Many of these injuries are associated with significant morbidity, and many require surgical treatment. The knee is the most common site of injury by some distance, with the most common injuries being damage to the anterior cruciate ligament (ACL) and the medial collateral ligament (MCL). The shoulder, hand/wrist and the lower leg are the next most commonly injured sites. Injuries to the head and neck, including sport-related concussions, are increasingly being reported. While men appear more likely to be injured than women, the rate of knee injuries, especially ACL injuries, is substantially higher among female skiers.

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There has been a change in injury patterns since the 1970s, particularly those involving the lower extremity. With improvements in equipment design and increased helmet use, the trend has been toward a decreasing number of skiing-related injuries of all types.  This is in the region of a 50% reduction in the overall injury rate. The types of injuries sustained have also changed over time, most notably with a decreased incidence of tibial fractures and an increased incidence of ACL injuries of the knee.

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The majority of injuries that occur while skiing or snowboarding involve acute trauma. Unfortunately, many of these require ongoing care and, in some cases, surgery. An early diagnosis is critically important to minimise pain, frustration and delays in treatment.

Here are some key things to consider to help make an early diagnosis, when to arrange imaging studies, and when to refer a patient for an early assessment.

1. If your patient cannot weight-bear following their injury, this is a relatively reliable indicator of a more significant injury. A good evidence-based example of this relates to the Ottawa ankle rules, although these are less relevant for skiing-related injuries. You should consider obtaining an x-ray to rule out a fracture.
2. If a patient reports that their knee became visibly swollen after an injury or presents with an effusion, this is a very sensitive sign of an injury to the internal structures. These include the knee cartilage, menisci and cruciate ligaments. These structures are among the most frequently injured structures within the knee while on the mountain and (in most cases) are not well visualised on x-rays. Due to their intra-articular location, ultrasound studies are also not helpful. In many cases, an MRI scan is an important next step.
3. Thumb injuries are arguably the most common single skiing injury, so common that one ligamentous injury is known as “Skier’s thumb” (we covered skiers thumb in more detail here). These injuries are often not reported as patients do not perceive them to be especially serious. Unfortunately, many of these injuries require a period of immobilisation or surgical treatment. As a result, an early review, and in most cases an x-ray, is generally advisable. Comparing laxity between the injuries and uninjured thumbs is advised, as is assessing laxity in both an extended and slightly flexed position.
4. Skiers who are beginners, children, or adolescents are at increased risk for lower leg fractures, with children younger than 10 years having a 9 times greater risk than older skiers. You should have a low threshold to arrange a medical review, or x-ray imaging when assessing kids who sustain an injury on the slopes.
5. Injuries to the tibial plateau, the weight-bearing surface of the knee, are becoming more common. It is thought that this might be because of the increasing age of the skiing population. These injuries must be identified early as they often require early surgical management to preserve the joint surface. An x-ray will generally confirm (or refute) this diagnosis; however, MR imaging may be needed when there is a high degree of suspicion and a normal x-ray.
6. Concussion symptoms are not always immediately apparent and may be quite subtle. Have a low threshold to seek a medical assessment should you be concerned that your patient has sustained this type of injury. Remember too that concussions frequently present alongside other injuries, including neck sprains, lacerations and contusions and that in most cases, active treatment leads to a more rapid resolution of symptoms.

At Axis, we have a particular interest in assessing and managing acute injuries of all types. We keep protected sessions for patients who have sustained acute trauma and have preferential access to radiology services and other management strategies (like bracing or other orthotic devices). In most cases these are fully funded by ACC.

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To book your patient an appointment at one of our clinics please call

1. Auckland 09 521 9846‍
2. Queenstown 03 777 4132

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