Evolution of ACL Ruptures in French Ski Resorts 1992–1999

This work done by 72 French doctors in the “Médecins de Montagne” skiing safety network studies the evolution of the rate of ACL ruptures since 1992. The study was done on 232 571 injuries including 21 303 ACL ruptures. Alpine skiing ACL ruptures, which have been increasing since 1992, represent 12.5% of accidents (3125 MDBI). A control group is analyzed each season through interviews at the bottom of the slopes in parking lots and random evaluations. We have ascertained that ACL ruptures represent 9.2% of total injuries in men, in comparison with 20% in women, over 24 years old. The case-control study, women versus men, stratified by age group, shows a remarkable ODDS ratio for adults (over 16 years old) with an extremely reduced confidence interval at 95% (3.26 < 3.41 < 3.56). The ISO adjustment charts do not currently take into account a major risk factor, the feminine sex. Among the possible preventive measures that can be taken for ACL ruptures in women is to evoke the decrease in adjustment values. There are no studies that prove the effectiveness of a decrease in adjustment values on the incidence of ACL ruptures, but there are corroborating arguments in favor of a positive action. The only risks of a decrease in the adjustment are extremely low, in particular that of inadvertent release. Different authors have demonstrated the possibility of a decrease in adjustment without inadvertent release. We suggest, beside the education of the skiers, in the prevention of the phantom foot, a 15% decrease in binding adjustment values for women over 25 years old, and 30% for beginners with less than 7 days of skiing.