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. 2025 Mar;53(3):640-648.
doi: 10.1177/03635465241307212. Epub 2025 Jan 20.

Return to On-Snow Performance in Ski Racing After Anterior Cruciate Ligament Reconstruction

Nathaniel Morris  1   2 , Ricardo da Silva Torres  3   4 , Mark Heard  5 , Patricia Doyle Baker  2 , Walter Herzog  2 , Matthew J Jordan  1   2   6
Affiliations

Return to On-Snow Performance in Ski Racing After Anterior Cruciate Ligament Reconstruction

Nathaniel Morris et al. Am J Sports Med. 2025 Mar.

Abstract

Background: The individual variation in on-snow performance outcomes after anterior cruciate ligament (ACL) reconstruction (ACLR) in elite alpine ski racers has not been reported and may be influenced by specific injury characteristics.

Purpose: To report the performance statistics of elite ski racers before and after ACLR and to identify surgical and athlete-specific factors that may be associated with performance recovery.

Study design: Descriptive epidemiological study.

Methods: International Ski and Snowboard Federation (FIS) points, FIS ranking, average placing, and average percentage behind the winning time in each race were calculated for 30 national and provincial team ski racers at 1 year before and 3 years after ACLR. Injury characteristics were obtained from operative reports and clinical notes.

Results: The mean age at the time of primary ACLR was 21.6 ± 3.5 years. Overall, 27 of 30 (90%) ski racers returned to the same preinjury competition level. Yet, only 16 of 30 (53%) improved in FIS points, and 13 of 30 (43%) improved in FIS ranking, in one of the speed or technical disciplines by 3 years after surgery. Of the skiers who improved in FIS points, 36% sustained multiligamentous injuries, 45% sustained meniscal tears, and 45% sustained chondral lesions. Of those who failed to improve in FIS points, 50% sustained multiligamentous injuries, 50% sustained meniscal tears, and 60% sustained chondral lesions. Meniscal tears and chondral lesions occurred mostly on the lateral side. The medial collateral ligament was involved in 8 of 9 multiligamentous injuries.

Conclusion: These findings suggest significant individual variation in the recovery of on-snow performance of ski racers after ACLR, despite returning to the same competition circuit. The pattern of secondary injuries alongside primary ACL ruptures showed little association with improved performance.

Keywords: alpine ski racing; anterior cruciate ligament; knee injury; return to performance.

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Conflict of interest statement

The authors declared that they have no conflicts of interest in the authorship and publication of this contribution. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

Figures

Figure 1.
Figure 1.
Pairwise comparisons of (A) International Ski and Snowboard Federation (FIS) points and (B) FIS ranking before and after anterior cruciate ligament reconstruction (ACLR) across disciplines. Lower FIS points indicate better performance. No data point for ACLR status indicates that the skier was not racing in the FIS circuit at this time point.
Figure 2.
Figure 2.
Pairwise comparisons of (A) average placing and (B) average percentage behind the winning time before and after anterior cruciate ligament reconstruction (ACLR) across disciplines and race categories. NAC, North American Cup; WC, World Cup; WSC, World Ski Championships.
Figure 3.
Figure 3.
Pairwise comparisons of (A) International Ski and Snowboard Federation (FIS) points and (B) FIS ranking for the control group identified through propensity score matching at the index age and at 3 years after the index age.
See this image and copyright information in PMC

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