Strategies: The Video Verite Approach to ACL Aid

May 2, 2004
Outside Magazine
Outside magazine, November 1995

Strategies: The Video Verite Approach to ACL Aid
By Kiki Yablon

There's no sound a skier dreads more than the fabled pop. And when U.S. Skiing's Diann Roffe heard it on December 19, 1990, she was third overall in the World Cup standings and, more immediately, burning up the downhill course at Morzine, France.

"I caught an edge on a gate and flipped," she recalls. "It felt like somebody had taken a hammer and hit me in the knee, quick and sharp." Roffe (now Roffe-Steinrotter) had joined the growing ranks of skiers who, despite rigorous conditioning, good equipment, and passable or even superior technique, have torn the most important stabilizing structure in the knee: the anterior cruciate ligament.

Despite decades of study, some 25 percent of all major reported ski injuries involve the ACL, and to the dismay of doctors, coaches, and alpine skiers everywhere there's absolutely no evidence that conditioning, general or specific, will prevent them. New research suggests, however, that some quality couch-potato time just might be the preparation that will keep you off the ski patrol sled.

In 1985, after watching the number of ACL injuries triple in less than a decade--while most other ski injury rates declined--Carl Ettlinger, founder of the ski consulting firm Vermont Safety Research, and two associates began trying to map the exact circumstances in which a knee blowout is imminent. "We looked at thousands of videos of people sustaining ACL injuries," says Ettlinger. They then showed these tapes to professional instructors, who began to identify and correct close calls in their everyday work.

Ettlinger and his associates pinpointed six elements that combine to form the most prevalent cause of ACL injury, which they dubbed the "phantom foot" scenario: all weight on the downhill ski tail, uphill arm back, off balance to the rear, hips below the knees, uphill ski completely unweighted, and upper body facing uphill. These six elements tended to come together when skiers tried to regain balance after a close call, sit down on the slide, or get up while still moving.

For the last two ski seasons, the Underhill, Vermont-based Vermont Safety Research has used the videotapes to train about 6,000 ski instructors and patrollers nationwide to recognize and correct their own skiing for phantom foot--and has recorded an unprecedented 60 percent drop in ACL injuries among their subjects. Other watch-and-learn skiers can obtain the $33 video ACL Awareness '96 at ski shops, ski schools, and orthopedic clinics, or order directly from Vermont Safety Research (802-899-4738).

If you need more incentive to study, consider that if you do suffer an ACL injury this season, you'll be faced with the option of reconstructive surgery, which usually involves harvesting a bit of your patellar tendon to replace the ruined ligament. Unless you ski for a living, that word "option" is key, but if you opt out, says Richard Steadman, physician for the U.S. Alpine Ski Team, prepare to tone down your athletic lifestyle. "You do a lot of rehab, wear a brace for any change-of-direction sports, and ski lesser terrain," he says.

Though submitting to the scalpel will cost you or your insurance company in the neighborhood of ten grand, and you six months to a year in physical therapy, it's been preferable for many athletes, and the success rate is high: Roffe-Steinrotter and her rebuilt joint came back to the tune of two Olympic medals.

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