Skiing

For Medical Students

What It Tests

A skiing history tests how the knee was loaded by a long lever, because the ski and boot extend the leg and transmit forces the knee has to resist. 3.15.6 covers the mechanics.

Asking about the equipment is unusual in a knee history and is essential here, because modern boots and bindings moved the injury from the tibia to the knee.

Asking about ability matters too, since the injury patterns differ between beginners and experienced skiers.

How It Is Performed

Ask whether the bindings released, because a binding that did not release transmitted the whole force to the knee.

Ask about the fall: a slow twisting fall, a backward fall onto the tails of the skis, or a high speed fall.

Ask about ability and conditions, since a beginner falling slowly and an expert falling fast produce different injuries.

Ask whether they could ski down or needed to be taken off the mountain.

Ask about swelling timing as always. 4.2.3 covers it.

What a Positive Means

A slow twisting fall with the ski acting as a lever and the binding not releasing is the classic medial collateral or cruciate mechanism in a beginner.

A backward fall with the knee flexed and the boot pushing the tibia forwards is the phantom foot mechanism and is a classic anterior cruciate injury in an experienced skier.

A high speed fall with multidirectional laxity is a high energy injury and may be a dislocation. 4.23.6 covers the assessment.

A valgus twisting fall produces a medial structure injury, which is the commonest skiing knee injury overall. 4.12.1 covers the assessment.

Pain without a fall, developing over a ski week, is usually a loading or patellofemoral problem rather than an injury.

MRCS Level

What a Positive Means

The reasoning expected is that equipment changes the forces, which is unusual among knee mechanisms and is the point of this page.

A stiff high boot prevents ankle motion, so rotational and bending forces pass to the knee rather than being absorbed below it.

The ski adds length, so a small angular displacement at the tip produces a large moment at the knee.

Bindings are designed to release at thresholds that protect the tibia, and the knee is loaded below those thresholds, which is why the injury moved upwards as equipment improved. 3.17.8 covers the general principle of a solution relocating a problem.

A medial collateral injury is the commonest skiing knee injury and is usually managed non-operatively. 4.12.1 covers it.

How Good It Is

The skiing history performs well because the fall is usually a discrete, memorable event and the equipment question is factual.

The binding question is the single most useful one and it is almost never asked.

It performs well for distinguishing the beginner pattern from the expert pattern, which maps onto different structures.

It performs poorly for grading, as all acute histories do, and the examination at two to six weeks is more informative than the one on return from the mountain.

FRCS Level

How Good It Is

At decision level the skiing history matters because most skiers are recreational, which changes the reconstruction conversation.

A patient who skis one week a year and has an isolated medial injury does not need surgery, and the history is what establishes both halves of that.

A patient whose cruciate injury prevents the activity they travel for has a real indication even though they are not an athlete, and dismissing recreational demand is a recognisable error.

The timing of the ski season is a legitimate factor in elective planning and should be named as a preference rather than disguised as a clinical reason.

A combined medial and cruciate injury from a skiing mechanism needs the medial component assessed properly, and this is the commonest under-treated combination in this group. 4.12.7 covers it.

Where It Misleads

The commonest error is assuming a recreational skier has low demand. A week of skiing is a high demand week.

The second is not asking about the equipment, which loses the most informative question on the page.

The third is attributing a knee injury sustained abroad to the imaging done abroad, where the sequences and the reporting may differ and a repeat assessment is reasonable. 4.2.33 covers previous imaging.

And a skiing injury in an older patient may be a degenerate structure failing, with a history that sounds like a minor fall.

Fellowship Level

Where It Misleads

In referred practice the skier presents with a chronic medial injury that was assumed to have healed, or with a knee that has been reconstructed and is unstable on skis specifically.

A knee stable in daily life and unstable on skis is being loaded by the lever the sport supplies, and the useful question is whether the rotational component was addressed. 4.14.3 covers the pattern.

A chronic medial injury with valgus laxity and a reconstructed cruciate is the combination that most often produces graft stretching, because the medial laxity loads the graft. 4.12.8 covers the assessment.

Equipment remains relevant at this level: a patient skiing on inappropriately set bindings is modifiable in a way the knee is not.

No figure here supports these claims, under decision 023.