Skip to main content
SpringerLink
Log in

Alpine Ski Bindings and Injuries

Current Findings

  • Review Article
  • Published:
Sports Medicine Aims and scope Submit manuscript

Abstract

In spite of the fact that the overall incidence of alpine ski injuries has decreased during the last 25 years, the incidence of serious knee sprains usually involving the anterior cruciate ligament (ACL) has risen dramatically since the late 1970s. This trend runs counter to a dramatic reduction in lower leg injuries that began in the early 1970s and to date has lowered the risk of injury below the knee by almost 90%.

One of the primary design objectives of modern ski boots and bindings has been to protect the skier from tibia and ankle fractures. So, in that sense, they have done an excellent job. However, despite advances in equipment design, modern ski bindings have not protected the knee from serious ligament trauma.

At the present time, we are unaware of any binding design, settings or function that can protect both the knee and lower extremities fromserious ligament sprains. No innovative change in binding design appears to be on the horizon that has the potential to reduce the risk of these severe knee injuries. Indeed, only 1 study has demonstrated a means to help reduce this risk of serious knee sprains, and this study involved education of skiers, not ski equipment.

Despite the inability of bindings to reduce the risk of severe knee injuries there can be no doubt that improvement in ski bindings has been the most important factor in the marked reduction in incidence of lower leg and ankle injuries during the last 25 years. The authors strongly endorse the application of present International Standards Organisation (ISO) and American Society for Testing and Materials (ASTM) standards concerning mounting, setting and maintainingmodern ’state of the art’ bindings.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Burns TP, Steadman JR, Rodkey WG. Alpine skiing and the mature athlete. Clin Sports Med 1991; 10: 327–42

    PubMed  CAS  Google Scholar 

  2. Kannus P, Johnson RJ. Downhill skiing injuries: trends to watch for this season. J Musculoskel Med 1991; 8: 13–32

    Google Scholar 

  3. Chissell HR, Feagin Jr JA, Warme WJ, et al. Trends in ski and snowboard injuries. Sports Med 1996; 22: 141–5

    Article  PubMed  CAS  Google Scholar 

  4. Ettlinger CF, Johnson RJ, Shealy JE. A method to help reduce the risk of serious knee sprains incurred in alpine skiing. Am J Sports Med 1995; 23: 531–7

    Article  PubMed  CAS  Google Scholar 

  5. Johnson RJ, Pope MH. Epidemiology and prevention of skiing injuries. Ann Chir Gynaecol 1991; 80: 110–5

    PubMed  CAS  Google Scholar 

  6. Natri A, Järvinen M, Kannus P, et al. Changing injury pattern of acute anterior cruciate ligament tears treated at Tampere University Hospital in the 1980s. Scand J Med Sci Sports 1995; 5: 100–4

    Article  PubMed  CAS  Google Scholar 

  7. Johnson RJ, Ettlinger CF, Shealy JE. Skier injury trends: 1972 to 1994. In: Johnson RJ, Mote Jr CD, Ekeland A, editors. Skiing trauma and safety. Eleventh International Symposium, ASTM STP 1289. Philadelphia: American Society for Testing and Materials, 1997: 37–48

    Google Scholar 

  8. Johnson RJ, Ettlinger CF, Shealy JE. Skier injury trends: 1972 to 1990. In: Johnson RJ, Mote Jr CD, Zelcer J, editors. Skiing trauma and safety. Ninth International Symposium, ASTM STP 1182. Philadelphia: American Society for Testing and Materials, 1993: 11–22

    Chapter  Google Scholar 

  9. Paletta GA, Warren RF. Knee injuries and alpine skiing. Sports Med 1994; 17: 411–23

    Article  PubMed  CAS  Google Scholar 

  10. Ryder SH, Johnson RJ, Beynnon BD, et al. Prevention of ACL injuries. J Sports Rehab 1997; 6: 80–96

    Google Scholar 

  11. Järvinen M, Kannus P, Johnson RJ. How to treat knee ligament injuries? Ann Chir Gynaecol 1991; 80: 134–40

    PubMed  Google Scholar 

  12. Renström P. Sports traumatology today: a review of common current sports injury problems. Ann Chir Gynaecol 1991; 80: 81–93

    PubMed  Google Scholar 

  13. Johnson RJ, Beynnon BD, Nichols CE, et al. The treatment of injuries of the anterior cruciate ligament. J Bone Joint Surg 1992; 74 (1): 140–51

    PubMed  CAS  Google Scholar 

  14. Kannus P, Järvinen M. Conservatively treated tears of the anterior cruciate ligament: long-term results. J Bone Joint Surg 1987; 69 (7): 1007–12

    Google Scholar 

  15. Johnson RJ, Pope MH. Ski binding biomechanics. Physician Sportsmed 1982; 10: 49–55

    Google Scholar 

  16. Mote Jr CD. Snow falls: the mechanics of skiing injuries. Mech Engineer 1984; 106: 94–102

    Google Scholar 

  17. Ekeland A. The knees are in danger in skiing [editorial]. Scand J Med Sci Sports 1995; 5: 61–3

    Article  PubMed  CAS  Google Scholar 

  18. Johnson RJ, Pope MH, Ettlinger CF. Ski injuries and equipment function. J Sports Med 1974; 2: 299–307

    Article  PubMed  CAS  Google Scholar 

  19. Shealy JE. Overall analysis of NSAA/ASTM Data on skiing injuries for 1978 through 1981. In: Johnson RJ, Mote Jr CD, editors. Skiing trauma and safety. Fifth International Symposium, ASTM STP 860. Philadelphia: American Society for Testing and Materials, 1985: 302–13

    Chapter  Google Scholar 

  20. Johnson RJ, Ettlinger CF, Shealy JE. Skier injury trends. In: Johnson RJ, Mote Jr CD, Binet M-H, editors. Skiing trauma and safety. Seventh International Symposium, ASTM STP 1022. Philadelphia: American Society for Testing and Materials, 1989: 25–31

    Chapter  Google Scholar 

  21. Shealy JE. Comparison of downhill ski injury patterns: 1978–81 vs 1988–90. In: Johnson RJ, Mote Jr CD, Zelcer J, editors. Skiing trauma and safety. Ninth International Symposium, ASTM STP 1182. Philadelphia: American Society for Testing and Materials, 1993: 23–32

    Chapter  Google Scholar 

  22. Warme WJ, Feagin Jr JA, King P, et al. Ski injury statistics, 1982 to 1993, Jackson Hole ski resort. Am J Sports Med 1995; 23: 597–600

    Article  PubMed  CAS  Google Scholar 

  23. Johnson RJ. Prevention of cruciate ligament injuries. In: Feagin Jr JA, editor. The crucial ligaments. New York: Churchill Livingstone, 1988: 349–56

    Google Scholar 

  24. Stevenson H, Webster J, Johnson R, et al. Gender differences in knee injury epidemiology amongst competitive alpine ski racers. Iowa Orthop J 1998; 18: 64–6

    PubMed  CAS  Google Scholar 

  25. Elmqvist LG, Johnson RJ. Prevention of cruciate ligament injuries. In: Feagin Jr JA, editor. The crucial ligaments. 2nd ed. New York: Churchill Livingstone, 1994: 495–505

    Google Scholar 

  26. Järvinen M, Natri A, Laurila S, et al. Mechanisms of anterior cruciate ligament ruptures in skiing. Knee Surg Sports Traumatol Arthrosc 1994; 2: 224–8

    Article  PubMed  Google Scholar 

  27. Chambat P, Siegrist O, Neyret P, et al. ACL rupture mechanism during skiing [abstract no 57]. Twelfth International Symposium on Ski Trauma and Safety; 1997 May 4–10; Whistler, Canada, 70

  28. McConkey JP. Anterior cruciate ligament rupture in skiing: a new mechanism of injury. Am J Sports Med 1986; 14: 160–4

    Article  PubMed  CAS  Google Scholar 

  29. Beynnon B, Howe JG, Pope MH, et al. The measurement of anterior cruciate ligament strain in vivo. Int Orthop 1992; 16: 1–12

    Article  PubMed  CAS  Google Scholar 

  30. Chiang AL, Mote Jr CD. Translations and rotations across the knee under isometric quadriceps contraction. In: Johnson RJ, Mote Jr CD, Zelcer J, editors. Skiing trauma and safety. Ninth International Symposium, ASTM STP 1182. Philadelphia: American Society for Testing and Materials, 1993: 62–74

    Chapter  Google Scholar 

  31. Aune AK, Schaff P, Nordsletten L. Contraction of knee flexors and extensors in skiing related to the backward fall mechanism of injury to the anterior cruciate ligament. Scand J Med Sci Sports 1995; 5: 165–9

    Article  PubMed  CAS  Google Scholar 

  32. Aune AK, Cawley PW, Ekeland A. Quadricepsmuscle contraction protects the anterior cruciate ligament during anterior tibial translation. Am J Sports Med 1997; 25: 187–90

    Article  PubMed  CAS  Google Scholar 

  33. Johnson RJ, Ettlinger CF, Campbell RJ, et al. Trends in skiing injuries: analysis of a 6-year study (1972 to 1978). Am J Sports Med 1980; 8: 106–13

    Article  PubMed  CAS  Google Scholar 

  34. Ettlinger CF, Johnson RJ. The state of the art in preventing equipment-related alpine ski injuries. Clin Sports Med 1982; 1: 199–207

    PubMed  CAS  Google Scholar 

  35. Shealy JE, Geyer LH, Hayden R. Epidemiology of ski injuries: effect of method of skill acquisition and release binding accident rates. Hum Factors 1974; 16: 459–73

    PubMed  CAS  Google Scholar 

  36. Bahniuk E, Zamir I. Characteristics of antifriction devices used for ski bindings. Orthop Clin North Am 1976; 7: 105–15

    PubMed  CAS  Google Scholar 

  37. Tapper EM. Ski injuries from 1939 to 1978: the Sun Valley experience. Am J Sports Med 1978; 6: 114–21

    Article  PubMed  CAS  Google Scholar 

  38. Moritz JR. Ski injuries. Am J Surg 1959; 98: 493–505

    Article  PubMed  CAS  Google Scholar 

  39. Ellison AE, Carroll RE, Haddon W, et al. Skiing injuries: clinical study. Public Health Reports 1962; 77: 11–17

    Google Scholar 

  40. Spademan R. Lower-extremity injuries as related to the use of ski safety bindings. JAMA 1968; 203: 445–50

    Article  PubMed  CAS  Google Scholar 

  41. Eriksson E. Ski injuries in Sweden: a one year survey. Orthop Clin North Am 1976; 7: 3–9

    PubMed  CAS  Google Scholar 

  42. Johnson RJ, Ettlinger CF. Alpine ski injuries: changes through the years. Clin Sports Med 1982; 1: 181–97

    PubMed  CAS  Google Scholar 

  43. Ekeland A, Nordsletten L. Equipment related injuries in skiing: recommendations. Sports Med 1994; 17: 284–7

    Article  Google Scholar 

  44. Ungerholm S, Gustavsson J. Skiing safety in children: a prospective study of downhill skiing injuries and their relation to the skier and his equipment. Int J Sports Med 1985; 6: 353–8

    Article  PubMed  CAS  Google Scholar 

  45. Bouter LM, Knipschild PG, Volovics A. Binding function in relation to injury risk in downhill skiing. Am J Sports Med 1989; 17: 226–33

    Article  PubMed  CAS  Google Scholar 

  46. Hauser W. Experimental prospective skiing injury study. In: Johnson RJ, Mote Jr CD, Binet M-H, editors. Skiing trauma and safety. Seventh International Symposium, ASTM STP 1022. Philadelphia: American Society for Testing and Materials, 1989: 18–24

    Chapter  Google Scholar 

  47. Ekeland A, Holtmoen A, Lystad H. Lower extremity equipmentrelated injuries in alpine recreational skiers. AmJ Sports Med 1993; 21: 201–5

    Article  CAS  Google Scholar 

  48. Johnson RJ, Ettlinger CF, Shealy JE. Release characteristics of alpine ski binding systems. 8th International Symposium on Ski Trauma and Skiing Safety; 1989 May 18; Riksgransen, Sweden, 32

  49. Deibert MC, Aronsson DD, Johnson RJ, et al. Skiing injuries in children, adolescents, and adults. J Bone Joint Surg 1998; 80 (1): 25–32

    Article  PubMed  CAS  Google Scholar 

  50. Young LR. Elevated racer binding settings and inadvertent releases. In: Johnson RJ, Mote Jr CD, Binet M-H, editors. Skiing trauma and safety. Seventh International Symposium, ASTM STP 1022. Philadelphia: American Society for Testing and Materials, 1989: 222–7

    Chapter  Google Scholar 

  51. Ungerholm S, Gierup J, Gustavsson J, et al. Skiing safety in children: adjustment and reliability of the bindings. Int J Sports Med 1984; 5: 325–9

    Article  PubMed  CAS  Google Scholar 

  52. Blitzer CM, Johnson RJ, Ettlinger CF, et al. Downhill skiing injuries in children. Am J Sports Med 1984; 12: 142–7

    Article  PubMed  CAS  Google Scholar 

  53. Johnson SJ. Anterior cruciate ligament injury in elite alpine competitors. Med Sci Sports Exerc 1995; 27: 323–7

    PubMed  CAS  Google Scholar 

  54. ASTM standard F1063. Standard practice for functional inspection and adjustments of alpine ski/binding/boot systems. Vol. 15.07. End use products. In: 1997 Annual book of ASTM standards. West Conshohocken (PA): American Society for Testing and Materials, 1997: 659–65

  55. ASTM standard F1064. Standard practice for sampling and inspection of complete and incomplete alpine ski/binding/boot systems in rental applications. Vol. 15.07. End use products. In: 1997 Annual book of ASTM standards. West Conshohocken (PA): American Society for Testing and Materials, 1997: 666–72

  56. Johnson RJ, Pope MH, Weisman G, et al. Knee injury in skiing: a multifaceted approach. Am J Sports Med 1979; 7: 321–7

    Article  PubMed  CAS  Google Scholar 

  57. Mote Jr CD, Hull ML. Fundamental considerations in ski bindings analysis. Orthop Clin North Am 1976; 7: 75–94

    PubMed  Google Scholar 

  58. Ettlinger C, Bahniuk E. A method for the testing and analysis of alpine ski bindings. J Safe Res 1980; 12: 4–12

    Google Scholar 

  59. Ettlinger CF, Johnson RJ. Can knee injuries be prevented? Skiing 1991 Mar; 43 (7): 120–3

    Google Scholar 

  60. Fujiya H, Churchill DL, Johnson CC, et al. The effect of muscle forces on ACL strain under applied internal/external torque [abstract]. 44th Annual Meeting of the Orthopaedic Research Society; 1998 Mar 16–19; New Orleans, 615

  61. Eseltine K, Hull ML. An alpine ski binding with electrically modulated twist release. In: Johnson RJ, Mote Jr CD, Zelcer J, editors. Skiing trauma and safety. Ninth International Symposium, ASTM STP 1182. Philadelphia: American Society for Testing and Materials, 1993: 200–12

    Chapter  Google Scholar 

  62. Piziali RL, Nagel DA, Koogle T, et al. Knee and tibia strength in snow skiing. In: Johnson RJ, Hauser W, Magi M, editors. Skiing trauma and safety IV. Munich: Technischer Überwachungs-Verein (TUV), 1982: 24–31

    Google Scholar 

  63. ASTM standard F939-93. Standard practice for selection of release torque values for alpine ski bindings. Vol. 15.07. End use products. In: 1997Annual book of ASTMstandards.West Conshohocken (PA): American Society for Testing and Materials, 1997: 516–8

  64. Wittman G. Biomechanische Untersuchungen zum Verletzungsschutz im alpinen Skisport [doctoral dissertation]. Munich: Technical Univ Munchen, 1973

    Google Scholar 

  65. Asang E. Applied biomechanics of the human leg: a basis for individual protection from skiing injuries. Orthop Clin North Am 1976; 7: 95–103

    PubMed  CAS  Google Scholar 

  66. Shealy JE, Ettlinger CF. An investigation of ski binding settings based upon minimum retention requirements. In: Hauser W, Karlsson J, Magi M, editors. Skiing trauma and safety IV. Munich: Technischer Überwachungs-Verein (TUV), 1982: 113–21

    Google Scholar 

  67. Crawford RP, Mote Jr CD. Ski binding minimum retention requirements. In: Johnson RJ, Mote Jr CD, Ekeland A, editors. Skiing trauma and safety. Eleventh International Symposium, ASTM STP 1289. Philadelphia: American Society for Testing and Materials, 1997: 93–108

    Google Scholar 

  68. Caldwell B, Landry D, Hull ML. A new mechanical ski binding with heel release activated by the bending moment at the boot sole. In: Johnson RJ, Mote Jr CD, Zelcer J, editors. Skiing trauma and safety. Ninth International Symposium, ASTM STP 1182. Philadelphia: American Society for Testing and Materials, 1993: 189–99

    Chapter  Google Scholar 

  69. Quinn TP, Mote Jr CD. Prediction of the loading along the leg during snow skiing. In: Johnson RJ, Mote Jr CD, Zelcer J, editors. Skiing trauma and safety. Ninth International Symposium. ASTM STP 1182. Philadelphia: American Society for Testing and Materials, 1993: 128–49

    Chapter  Google Scholar 

  70. Hull ML, Swanstrom M, Wade B. Electromechanical ski release binding withmechanical backup. In: Johnson RJ, Mote Jr CD, Ekeland A, editors. Skiing trauma and safety. Eleventh International Symposium, ASTM STP 1289. Philadelphia: American Society for Testing and Materials, 1997: 81–92

    Google Scholar 

  71. Ettlinger CF. 1991 and beyond. Skiing 1987 Spr; 40 (8): 95–7

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopaedics and Rehabilitation, Sports Medicine Division, McClure Musculoskeletal Research Center, The University of Vermont College of Medicine, Robert T. Stafford Hall, Burlington, Vermont, 05405-0084, USA

    Antero Natri,  Bruce D. Beynnon & Robert J. Johnson

  2. Section of Orthopaedics, Department of Surgery, Tampere University Hospital, University of Tampere, and Tampere Research Center of Sports Medicine, UKK Institute, Tampere, Finland

    Antero Natri

  3. Vermont Ski Safety Equipment Inc., Underhill, Vermont, USA

    Carl F. Ettlinger

  4. Department of Industrial and Manufacturing Engineering, Rochester Institute of Technology, Rochester, New York, USA

    Jasper E. Shealy

Authors
  1. Antero Natri
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Bruce D. Beynnon
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Carl F. Ettlinger
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Robert J. Johnson
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jasper E. Shealy
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Bruce D. Beynnon.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Natri, A., Beynnon, B.D., Ettlinger, C.F. et al. Alpine Ski Bindings and Injuries. Sports Med 28, 35–48 (1999). https://doi.org/10.2165/00007256-199928010-00004

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00007256-199928010-00004

Keywords

Search

Navigation