Non-operative Treatment of ACL Injuries due to Skiing

ACL reconstruction is typically indicated for ACL tears in young athletes to allow sports participation and reduce the risk of further damage to their articular cartilage. Similarly, many ACL skiing injuries are treated with surgery. However, some patients can be treated nonoperatively. In fact, about 25% of ACL tears from recreational ski injuries heal by themselves. One reason for this could be that ACL tears from skiing are often less traumatic than the tears due to pivot sports (e.g., soccer or football).

Most skiers report tearing their ACL during a tumble in which their ski rotates too far. In Dr. Marx’s practice, some of these recreational alpine skiers (who did not undergo surgery after their injury) have been found to have normal laxity and a negative pivot shift examination at 6—12 weeks after ACL injury, indicating no knee instability. Even 2 years post-injury, the majority of these patients had normal knee laxity and still did not need ACL reconstruction1. As Dr. Marx notes, it is important that “patients who tear their ACL during recreational skiing do not rush to schedule surgery right after their injury, and instead wait to be reevaluated at 6 weeks. The majority do not heal without surgery, but those who do receive a pass to avoid surgery and recovery!”

An estimated 150,000 ACL surgeries are performed each year in the United States, as the New York Times reports. The fact that some skiing injuries may be treated non-operatively is a “huge deal,” according to Dr. Marx. By avoiding surgery, these patients can reduce their medical costs and recovery time. Ultimately, as with any treatment plan, the decision for non-operative treatment should be assessed carefully on a case-by-case basis, and should be individualized for each patient.

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1. Hestroni I, Delos D, Fives G, Boyle BW, Lillemoe K, Marx RG. Nonoperative treatment for anterior cruciate ligament injury in recreational alpine skiers. KSSTA. 2013; 21(8):1910-4.

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