Ski safe: Top tips to prevent ACL tears on the ski slopes

Written by: Mr Amir Qureshi
Edited by: Sophie Kennedy

One of the most common ski injuries is a tear to the anterior cruciate ligament (ACL) in the knee, which is likely to cut short fun on the ski slopes. We asked leading consultant knee surgeon and limb reconstruction specialist Mr Amir Qureshi to share his top tips on preventing this type of injury while skiing.





ACL tears are one of the most common ski injuries. How do they happen?


An ACL is ruptured mainly when there is a twisting injury with a sideways force. When you’re skiing, one foot often gets planted, your body twists and your leg and your knee go sideways. That’s the perfect mechanism for you to rupture your anterior cruciate ligament, or ACL as it’s commonly called.



How are full ACL tears treated?


The treatment of ACL injuries really depends on the patient and whether there have been other injuries sustained in the knee together with the ACL. Before making a decision about treatment, I like to take a full history and also establish what the expectations of the patients.


Sometimes, if only the ACL is injured, a course of physiotherapy and strengthening the leg is enough to support a good recovery. However, in any case, it’s important to keep a watchful eye on the patient’s recovery and if, for example, they couldn’t go back to the sport that they love, we could intervene more urgently.


The other thing that’s important to consider is if the meniscus, the knee’s shock absorber, is also damaged together with the ACL. A torn meniscus can lead to earlier wear and tear on the knee and ideally, in both younger and older patients, I like to repair or remove the meniscus rather than let it degenerate away. The aim of repairing the meniscus is to stabilise the knee. In the case that the ACL has ruptured as well, I would likely advocate a reconstruction of the ACL at the same time as the meniscal repair. This would give the best chance of healing and would prevent the after effects of not having a complete meniscus over the coming years.



How can people avoid having an ACL tear in skiing?


To avoid getting an ACL injury in the first place there are a number of steps someone could take. First of all, prepare for your ski holiday. Just as you would prepare for a marathon, there are specific exercises, including working on your legs, to prepare for skiing. Ideally, you could perhaps visit a physiotherapist who could guide you on the proper exercises. This should be four to six weeks before going on your skiing holiday.


As we discussed earlier, one of the main causes of an ACL injury is a planted foot which can often occur when the binding hasn’t come off. So, no matter how experienced you are for the first run, I would advise keeping very loose bindings. This means that if something goes wrong while you are still finding your ski legs, the ski will most likely detach itself and you won’t have that horrible, twisting, sideways movement to your knee.


The other thing to consider is that a significant amount of time may have passed since you last skied. Perhaps a whole year has passed but more likely, especially now in our recent times, it may have been two or three years without practising. Most of the ski injuries I see happen right at the beginning of the holiday, where someone has gone straight back to level where they left off. I also see many injuries occurring towards the end of the patient’s holiday, when perhaps a few more risks have been taken.


For this reason, no matter how experienced a skier you are, I recommend start on the nursery slopes for your very first run, then progressing on to the green, then the blue and finally the red slopes. I appreciate that some blues can be trickier than reds and some reds can be an easy blue depending on how they have been graded. As embarrassing as it might sound, using a graded approach, only until you find your ski legs and get your muscle memory back, goes a long way to prevent injuries.


In summary, prepare well, start slow, even if just for an hour or a morning, with looser bindings and go for the more advanced stuff once you’ve got your muscle memory back.



If you are seeking treatment for an ACL or meniscal tear, you can book a consultation with Mr Qureshi by visiting his Top Doctors profile.

By Mr Amir Qureshi
Orthopaedic surgery

Mr Amir Qureshi is an internationally-trained consultant knee surgeon and limb reconstruction specialist in the Southampton area. His specialities are knee surgery, knee replacement, revision knee surgery alongside sports injuries, meniscal injuries, and knee arthroscopy. Other interests include - but are not limited to; osteotomy, limb deformities, problem fractures as well as bone infection, joint preservation and autologous chondrocyte implantation.

Mr Qureshi's orthopaedic training started after he graduated from University of Wales College of Medicine. He received the Lloyd Griffiths Medal award for trainee with greatest input towards the programme while at the renowned Robert Jones and Agnes Hunt Orthopaedic Hospital. Throughout all of his training years, he worked under the guidance of highly-experienced leaders in their fields.

After finishing his higher surgical training, Mr Qureshi decided to further his expertise by doing two international fellowships. The first was hip and knee surgery at the Australian Orthopaedic Association, while he was simultaneously an honorary lecturer at the University of Adelaide. The second was limb reconstruction at The Russian Ilizarov Scientific Centre for Restorative Traumatology, where Mr Qureshi learned highly-advanced techniques and procedures.

Currently, Mr Qureshi is teaching and conducting research outside of his clinic hours. He is an honorary senior clinical lecturer at University Hospital Southampton (UHS), where he is also the postgraduate education lead for orthopaedics. Previously he was the department clinical lead for medical students. Mr Qureshi attends international scientific meetings and gives invited lectures. He is a keen teacher who has been awarded the Wessex Trainer of the Year award in consecutive years, and received the Hospital Heroes badge from UHS.

Mr Qureshi has had multiple articles published in the national press, as well as many published in peer-reviewed journals. His present research, where he is principle investigator and has fully-funded the project's interests, includes the use of cartilage regenerative cells in the ABICUS trial and novel electromagnetically driven osteotomy surgery in the Ellipse HTO trial.

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