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

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.