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Ski season and ACL injuries
An interview with Mr Ghias Bhattee – Lower Limb Orthopaedic Surgeon on what to do if you get injured on the slopes.
It’s ski season. How can you help if someone gets injured?
My specialty area is issues with the ACL and ligament reconstructions of the knee. I have found that things do get busier for me during the ski season for sure!
Ligaments are tough bands of connective tissue. The ligaments in the knee hold three bones together – the thigh bone, the shin bone and the knee cap – and help keep the knee stable. There are four ligaments in the knee – two collateral ligaments on the sides of the knee and two cruciate ligaments inside the knee.
The ACL joins the thigh bone to the shin bone and runs diagonally through the inside of the knee. As well as giving the knee stability, it helps to control the back-and-forth movement of the lower leg.
When someone has an ACL injury, they will initially get pain and swelling. The swelling will eventually subside, but this type of injury doesn’t get better on its own, and will cause consistent pain. Without treatment, a person may also start to get symptoms of instability, which include weakness; the knee giving way; locking, catching or clicking when moving or bending the knee; and not being able to fully straighten the knee.
The treatment I recommend will depend on how bad their symptoms are and their level of activity. If someone feels their knee is stable, are older, and don’t have an active lifestyle, they may decide not to have ACL surgery. However, delaying surgery could cause further damage to the knee.
How could someone injure their ACL?
Knee injuries are pretty common for skiers and ACL injuries are one of the most common types of knee injuries.
Common causes of an ACL injury include:
- Landing incorrectly form a jump
- Suddenly stopping
- Suddenly changing direction
- Having a collision, which is a risk on ski slopes (beware drunk skiers!)
If the ACL is torn, the knee can become very unstable and lose its full range of movement. This can make it difficult to make certain movements, such as turning on the spot.
What does ACL treatment involve?
Generally for younger patients, they will need an ACL reconstruction. This is usually done by using some tendon taken from the patient and using this as a ligament.
Before
Before having the surgery, the patient will need to wait for any swelling to go down and for the full range of movement to return to the knee.
It’s likely to take at least three weeks after the injury took place for the full range of movement to return. During this time, it’s a good idea to see a physiotherapist to help prepare for the surgery.
During
The operation takes between 1 – 2 hours, is minimally invasive (keyhole) and no overnight stay in hospital is needed. Crutches will have to be used for two weeks and can be discarded after this.
After
For someone that has this operation, I recommend taking two weeks off to rest and recover, working from home for another two weeks after that, then once a month has gone by, a phased return to work.
As the first two weeks will be challenging, I would suggest stocking up on food that’s easy to cook, such as tinned foods, rice and pasta. You could also prepare a variety of meals in advance and put them in the freezer.
Put things you’ll need, such as books and magazines, where you can easily reach them.
For the first week or two post-surgery, if possible, it’s best to have someone to help at home.
Physiotherapy is essential to a good recovery, as it will help increase muscle strength, regain flexibility and range of movement. Generally, rehab takes around 6 to 12 months and during this time, certain activities will need to be restricted, such as more intense sports (e.g. skiing and football), but many other activities are possible, such as cycling and swimming.
What other injuries could someone sustain when skiing?
Skiing and winter sports can be pretty dangerous and accidents do happen. Common injuries include fractures, cartilage damage, torn ligaments and lots of knee injuries. Another common ligament injury is to the MCL (medial collateral ligament). The MCL lies on the inner side of your knee joint, and connects the thigh bone to the shin bone. Whilst an MCL injury may require surgery, it does respond well to bracing and conservative treatment methods, such as pain management and physio.
