Ski Knee Injury Specialist

The most commonly injured joint in snow sports is the knee. Your knees will be constantly absorbing impact from the slope whilst supporting your body weight. Control from a strong core, glutes, quads and hamstrings can help prevent injuries. There is often a turning or twisting motion during a fall on the slope. The combination of rigid boots and the potential for a ski or board to be caught in the snow, places these stresses through the knee. During this rotation there are a number of structures which are placed at risk. They can all be injured individually or in combination.

An early review is extremely important!

There will always be steps that can be initiated to speed up your recovery and these will have a knock-on effect on the outcome of further management. The aims are to reduce your time away from work and speed you back to high level sport.

When I first speak to you a detailed history of your injury will be the first step – forming a diagnosis and subsequent management plan. The type of activity, the movement and speed, and whether there was contact involved.

In the resort medical centre an initial assessment and plan is made and this will need to be repeated as soon as possible after you land back home.

The most useful initial investigation for a ligament, meniscal or cartilage injury is Magnetic Resonance Imaging (MRI). This scan uses a magnet to visualise the different types of anatomy in and around the knee and will confirm the type of injury sustained.

This can be booked for you straight after your initial video consultation, and routinely performed within 1 week of returning home.

A further appointment is required to assess recovery and the benefits gained from the physiotherapy and rehabilitation so far and to review the MRI. If surgery is indicated then most commonly it is for these procedures:

  • Anterior cruciate ligament reconstruction
  • Combined cruciate or collateral ligament reconstruction
  • Meniscal repair
  • Cartilage stabilisation or reconstruction

Whether surgery is required or not. It is important to ensure that there is a guided return to sport and there will be specific activities and exercises to focus on.

If surgery is indicated then pre-operative physiotherapy and optimisation is an important part of this pathway.

Keep in mind that early interventions will influence the speed of recovery.

BOOK SVEN SKI CLINIC

COMMON SNOW SPORT KNEE INJURIES

MEDIAL COLLATERAL LIGAMENT  (MCL)

The ligament supports the inside of the knee especially during rotation or bending outwards. It is formed from three distinct parts and a full rupture would include all three. Thankfully the ligament is most frequently sprained with an excellent healing potential if managed correctly from the start.

 

ANTERIOR CRUCIATE LIGAMENT (ACL)

One of two crossed cruciate ligaments within the knee joint. The ACL controls outward turning and forward movement of the tibia (anterolateral rotation). It is commonly injured and frequently requires surgery to recreate knee stability and allow a return to pivoting sports and activities. It is vital that the treatment for this injury starts immediately. A delay in reducing knee swelling and inflammation will cause stiffness and could influence the time and outcome from surgery.

MENISCAL TEARS

The menisci of the knee sit inside the joint on both the inside and outside. They aid stability by transmitting stress. They protect the joint cartilage. When the meniscus tears, it can be in a variety of different orientations and locations. The treatment is via an arthroscopy: key-hole surgery.

Examples of the different tears and my specific techniques for each include:

 

  • Bucket handle tear. The entire meniscus on one side of the knee tears and can flip as it remains attached at the front and back. It can cause the knee to lock. Treatment involves reducing it back in position and using multiple different key-hole stitching techniques to hold it securely in place.
  • Radial tear. The meniscus tears from the joint towards the capsule lining of the knee. Treatment involves a skilled mattress stitching technique to pull the two sides together without splitting the tissue.
  • Horizontal tear. The meniscus splits in two but often remains in place. Treatment involves stitching or sealing the two ‘leaves’ of meniscus together.
  • Parrot-beak tear. Usually a thin bucket-handle that has then split. A minimal resection of the trapped tissue can give immediate resolution of pain without delay to rehabilitation
  • Ramp tear. The meniscus splits at the very back near the capsule. Often associated with an ACL rupture. Stitches with permanent tiny plastic buttons into the capsule are deployed. This can ensure that the meniscus heals back in place
  • Root tear. A strong bony anchor point for the meniscus is pulled off. Without surgical treatment the meniscus will drift out of the joint. This is called extrusion and rapidly leads to destructive arthritis. The meniscus is stitched and pulled back down to the tibial bone to perfectly recreates the meniscal structure. The stitches pass through a bone tunnel and are secured with a tiny internal metal button on the outside of the bone

FRACTURES

The most common fracture near the knee is below the knee in the tibia which can extend into the knee joint (tibial plateau).

The tibia is so close to the skin that when it fractures the surrounding muscle and skin is at risk. If bone penetrates the skin it requires emergency surgery to reduce the risk of infection.

All fractures need to be reduced back into alignment and initially stabilised. The majority of tibial fractures then need definitive surgical internal fixation with plates, screws or nails. There are often different management and surgical approaches.

Use the time between initial management and surgery to get in contact. Early specialist advice to guide surgery is important for successful outcomes. Other fractures such as in the thigh (distal femur) and kneecap (patella) also need specialist bespoke management plans.