Did injury incidence in alpine ski racing change after equipment regulations? An evaluation based on the injury surveillance system of the Austrian Ski Federation

A Survey on Current Practices, Needs, Responsibilities and Preferences for Knowledge Dissemination in the Field of Injury and Illness Prevention Among Competitive Snow Sports Stakeholders

BACKGROUND

Injury and illness prevention practices in competitive snow sports must be better understood among stakeholders. In particular, there is a need for a greater understanding of what context-specific stakeholders require for prevention. Therefore, this study surveyed stakeholders' current practices, needs, responsibilities and knowledge dissemination preferences related to injury and illness prevention in competitive snow sports and described the main commonalities and differences between stakeholder groups.

METHODS

We conducted a cross-sectional study that used an online survey developed using Kipling's principle (the "5W1H" method) and targeted athletes, coaches, team staff, ski racing suppliers, and representatives from all competition levels and all competitive snow sports governed by the International Ski and Snowboard Federation. The data were analysed following both quantitative and qualitative descriptive analyses.

RESULTS

Most of the 436 respondents believed in and reported needing more information on injury and illness prevention. The participants stated that the main goal of prevention was to avoid injuries and minimise their time away from being on snow, and they stressed their different underlying motivations. Despite the differences across subgroups, participants highlighted knee and head injuries and concussions as their primary injury prevention targets and priorities for additional information. Respiratory and cardiovascular illnesses were reported as their main targets of illness prevention, but more information on all illnesses was reported. Current practices and priorities for additional information fell under athlete-, equipment-, snow/environment-, and course-related prevention areas. Moreover, stakeholders highlighted their need for more information on mental health and training. Shared responsibilities were identified across the development, dissemination, and implementation of prevention, along with stakeholders' preferred communication channels.

CONCLUSIONS

Our study provides meaningful insights across athlete, equipment-, snow/environment-, and course-related prevention areas related to snow sports, roles, and competition levels. These insights may inform the development, dissemination and further implementation of any tailored and context-driven preventive measure by better addressing end-users' needs. These findings may support successful future preventive interventions by providing key elements and a clear path to improve athletes' health and safety.

Snow sports-specific extension of the IOC consensus statement: methods for recording and reporting epidemiological data on injury and illness in sports

The International Olympic Committee's (IOC) consensus statement on 'methods for recording and reporting of epidemiological data on injury and illness in sport' recommended standardising methods to advance data collection and reporting consistency. However, additional aspects need to be considered when these methods are applied to specific sports settings. Therefore, we have developed a snow sports-specific extension of the IOC statement to promote the harmonisation of injury and illness registration methods among athletes of all levels and categories in the different disciplines governed by the International Ski and Snowboard Federation (FIS), which is also applicable to other related snow sports such as biathlon, ski mountaineering, and to some extent, para snow sports. The panel was selected with the aim of representing as many different areas of expertise/backgrounds, perspectives and diversity as possible, and all members were assigned to thematic subgroups based on their profiles. After panel formation, all members were provided with an initial draft of this extension, which was used as a basis for discussion of aspects specific to the discipline, application context, level and sex within their snow sports subgroup topic. The outcomes were then aligned with the IOC's existing consensus recommendations and incorporated into a preliminary manuscript draft. The final version of this snow sports-specific extension was developed and approved in two iterative rounds of manuscript revisions by all consensus panel members and a final meeting to clarify open discussion points. This snow sports-specific extension of the IOC statement is intended to guide researchers, international and national sports governing bodies, and other entities recording and reporting epidemiological data in snow sports to help standardise data from different sources for comparison and future research.

We know a lot about little and little about a lot: A contextualized scoping review on injury prevention in alpine ski racing

BACKGROUND

Our goal was to summarize and contextualize the available literature on alpine ski racing injury epidemiology, injury etiology, injury prevention measures, injury prevention context, and implementation issues.

MATERIALS AND METHODS

We searched four electronic databases using predetermined search terms. We included original studies that assessed injury, injury risk factors, and injury mechanisms, and assessed and reported the effect of an injury prevention measure in alpine ski racing. Two authors independently conducted title-abstract screening, and one performed the full-text review. For data synthesis and categorization, we used the Translating Research into the Injury Prevention Practice framework and a modified and adapted version of the Haddon matrix.

RESULTS

Of the 157 included studies, most corresponded to injury epidemiology and etiology, whereas few studies encompassed injury prevention measure development, implementation and evaluation. Preventive interventions targeting equipment, rules and regulations, course design and snow preparation were the most prevalent in the literature. Furthermore, various contextual factors in the current literature have been found, including gender, competition level, countries and federations, and time periods within a season.

CONCLUSIONS

We provided an in-depth and comprehensive overview of the current state-of-the-art in the alpine ski racing context. We know a lot about little and little about a lot across all the areas associated with injury prevention in such context. The limitations in the literature yield a road map for designing future injury prevention studies to address the key gaps identified. A more comprehensive context-driven approach throughout all stages of injury prevention would benefit the ultimate implementation of effective preventive strategies.

Collisions with another person while skiing and snowboarding: A 13-year national registry analysis

INTRODUCTION

Interindividual collisions while skiing or snowboarding occur regularly, they can be associated with severe injuries.

OBJECTIVE

To elucidate causes of accidents, injury patterns and potential risk factors for injury severity in interindividual collisions of skiers and snowboarders.

MATERIAL AND METHODS

Retrospective analysis of the Austrian Registry for Mountain Accidents within a 13-year timeframe (2005-2018) with regard to on- or off-piste collisions of skiers and snowboarders.

RESULTS

A total of 30,503 collisions, involving 52,430 (85.9%) skiers and 8,576 (14.1%) snowboarders were analysed. Denominators are lacking, since total numbers of skiers and snowboarders were not available. Compared to skiers, snowboarders were younger (23 vs. 42 years; p<0.001), predominantly male (77.4% vs. 61.0%; p<0.001) and less often severely injured (46.8% vs. 26.2%; p<0.001). Most accidents occurred on slopes (>95%). Collisions involving two snowboarders occurred proportionally more often in terrain parks (4.1% of 1,664 injured snowboarders; p<0.001) and while one victim was standing or sitting (9.7%; p<0.001). Contusions/strains/sprains were most prevalent (>23%), as were head injuries (>12%). In skiers, chest, shoulder, hip, thigh and knee injuries occurred more often, leading to fractures, dislocations, concussions and internal injuries more frequently. In snowboarders, spine/back, elbow, forearm, wrist and lower leg injuries were more prevalent. Female gender and standing or sitting prior to the accident was a risk factor for being more severely injured in collisions involving i) two skiers (OR: 4.02 (3.79-4.26) and 3.91 (3.26-4.68)), ii) a skier and a snowboarder (OR: 4.50 (3.95-5.14) and 11.49 (8.04-16.41)) or iii) two snowboarders (OR: 2.85 (2.12-3.84) and 12.47 (6.17-25.20)). Wearing a helmet increased the risk when two skiers collided (OR: 1.10 (1.03-1.17)). In skier vs. snowboarder collisions, the skier had a higher risk of being injured more severely (OR: 7.93 (6.98-9.01)).

CONCLUSIONS

In interindividual collisions of skiers and snowboarders, injury patterns and preceding causes differ substantially. Skiers are more likely to be severely injured. Awareness of an increased risk of injury should be raised particularly while standing or sitting on the slope.

Risk of Graft Rupture After Adding a Lateral Extra-articular Procedure at the Time of ACL Reconstruction: A Retrospective Comparative Study of Elite Alpine Skiers From the French National Team

BACKGROUND

Elite alpine skiing is associated with a particularly high risk of anterior cruciate ligament (ACL) injuries, including graft ruptures. Despite a considerable focus on prevention, a reduction in injury rates has not been observed since the 1980s.

PURPOSE

To determine whether elite alpine skiers undergoing ACL reconstruction (ACLR) with a lateral extra-articular procedure (LEAP) had a lower rate of ACL graft rupture when compared with those who underwent isolated ACLR.

STUDY DESIGN

Cohort study; Level of evidence, 3.

METHODS

Elite skiers from the French ski team who had undergone ACLR, with or without a LEAP, and had a minimum follow-up of 2 years were identified from the national ski team database. Rates of secondary ACL injury were determined via interrogation of the database, review of medical notes, and a final telemedicine interview. A multivariable analysis using the penalized Cox model was performed to explore the relationship among graft rupture, surgical procedure type, and any potential explanatory variables.

RESULTS

Among 81 ACLR procedures analyzed, 50 were isolated and 31 were combined with a LEAP, which was performed using modified Lemaire or anterolateral ligament reconstruction. Graft rupture rates were 34.0% in the isolated ACLR group and 6.5% in the ACLR + LEAP group. Multivariable analysis demonstrated that adding a LEAP was associated with a significant reduction in risk of ACL graft rupture when compared with isolated ACLR (hazard ratio [HR], 5.286 [95% CI, 1.068-26.149]; P = .0412). Age (HR, 1.114; P = .1157), sex (HR, 1.573; P = .3743), and ACL graft type (HR, 1.417; P = .5394) were not significant risk factors.

CONCLUSION

Combined ACLR and LEAP were associated with a significant reduction in the rate of ACL graft rupture in elite alpine ski athletes. Those treated with isolated ACLR remain at extremely high risk of a second ACL injury.

Predicting neuromuscular control patterns that minimize ACL forces during injury prone jump landing maneuvers in downhill skiing using a musculoskeletal simulation model

Competitive skiers encounter a high risk of sustaining an ACL injury during jump-landing in downhill ski racing. Facing an injury-prone landing manoeuvre, there is a lack of knowledge regarding optimum control strategies. So, the purpose of the present study was to investigate possible neuromuscular control patterns to avoid injury during injury-prone jump-landing manoeuvres. A computational approach was used to generate a series of 190 injury-prone jump-landing manoeuvres based on a 25-degree-of-freedom sagittal plane musculoskeletal skier model. Using a dynamic optimization framework, each injury-prone landing manoeuvre was resolved to identify muscle activation patterns of the lower limbs and corresponding kinematic changes that reduce peak ACL force. In the 190 injury-prone jump-landing simulations, ACL forces peaked during the first 50 ms after ground contact. Optimized muscle activation patterns, that reduced peak ACL forces, showed increased activation of the monoarticular hip flexors, ankle dorsi- and plantar flexors as well as hamstrings prior to or during the early impact phase (<50 ms). The corresponding kinematic changes were characterized by increased hip and knee flexion and less backward lean of the skier at initial ground contact and the following impact phase. Injury prevention strategies should focus on increased activation of the monoarticular hip flexors, ankle plantar flexors and rapid and increased activation of the hamstrings in combination with a flexed landing position and decreased backward lean to reduce ACL injury risk during the early impact phase (<50 ms) of jump landing.HighlightsFirst study investigating advantageous control strategies during injury-prone jump-landing manoeuvres in downhill skiing using a musculoskeletal simulation model and dynamic optimization framework.The simulation results predicted high injury risk during the first 50 ms after initial ground contact.Optimized neuromuscular control patterns showed adapted activation patterns (timing and amplitude) of muscles crossing the knee as well as the hip and ankle joints prior to and after initial ground contact, respectively.An optimized control strategy during an injury-prone landing manoeuvre was characterized kinematically by increasing hip and knee flexion and less backward lean of the skier at initial ground contact and the following impact phase.

Perceptions of experts on key injury risk factors in alpine ski racing as a function of stakeholder role and associated level of competition

Objectives

(1) To update experts' priorities of perceived key injury risk factors in alpine ski racing based on a framework and list derived 10 years ago, (2) to identify additionally emerging risk factors since then and (3) to compile a list with countermeasure suggestions.

Methods

A sample of 532 expert stakeholders (athletes, coaches, team medical staff, Ski Racing Suppliers (SRS) and International Ski Federation (FIS) representatives) from the World Cup (WC), European Cup (EC) and FIS-race level participated in a cross-sectional online survey. Experts were asked to name those risk factors with the highest believed impact on injury risk and rank them according to their current priority from a predefined list. In addition, experts were encouraged to name additional (not listed) risk factors and to suggest countermeasures.

Results

Regardless of stakeholder role and competition level, snow-related factors appeared to have the highest perceived priority. However, WC athletes' and coaches' perceptions were also related to equipment, while at the EC and FIS-race level fatigue and physical fitness-related factors were considered important. Athletes' perceptions were largely in agreement with SRS (ie, snow-related and equipment-related factors). At the same time, while coaches, team medical staff and FIS representatives additionally emphasised fatigue and physical fitness-related factors.

Conclusion

Experts' perceptions on key injury risk factors in alpine ski racing depend on the stakeholder role and differ between the competition levels. Thus, to develop effective prevention measures and to successfully implement them, all relevant stakeholders should be given a voice, and prevention efforts should be targeted to the specific level.

Acute on-snow severe injury events in elite alpine ski racing from 1997 to 2019: the Injury Surveillance System of the Austrian Ski Federation

OBJECTIVES

The study aimed to (1) determine the incidence and gender-specific risk ratio of acute on-snow severe injury events (SIE) in elite alpine ski racing, (2) examine the development of SIE over 22 seasons, and (3) analyse SIE with respect to the severely injured body parts and structures.

METHODS

Data recorded in the Austrian Ski Federation's Injury Surveillance System over 22 seasons were analysed. The Austrian Ski Team consists of four groups: Team National (n=477), Team A (n=444), Team B (n=696) and Team C (n=608). Team National and Team A comprised World Cup, Team B European Cup and Team C junior alpine ski racers. Simple and multiple Poisson regressions were calculated.

RESULTS

The SIE incidence was 15.7 (95% CI 14.2 to 17.5) per 100 skier seasons. ACL injury events accounted for 70.8% of severe knee injury events and 48.6% of SIE. The incidence of severe ACL injury events was 7.6 (95% CI 6.6 to 8.9). Female World Cup alpine ski racers had a 1.65 times (95% CI 1.02 to 2.69) higher risk of severe ACL injury events than their male counterparts.

CONCLUSION

The incidence of acute on-snow SIE in World Cup alpine ski racing was higher than previously reported. Despite various prevention efforts, the average seasonal incidence of SIE in World and European Cup alpine ski racers has grown from approximately 11 in 1997 to 23 in 2019; thus with roughly one more injured athlete every second season.