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The Future Of Knees


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To mix anatomical reality with anatomical metaphors, knees are the Achilles’ heel of skiing. They simply weren’t designed for the abuse we put them through, which is probably why a seasoned skier’s trademark tattoo is a surgery scar. While we can’t eliminate knee injuries, we can take critical preventative steps by finding out how they happen and who is most at risk.

For the past seven years, the Steadman-Hawkins Sports Medicine Foundation in Vail, Colo., has studied those factors through Vail Associates’ employee knee screening program. So far, 11,472 employees have been screened and their injuries tracked.

The screening-mandatory for all employees whose jobs require that they ski or snowboard- was conceived to lower Vail Associates’ workers’ compensation costs. It’s not a prohibitor of employment, but rather a way for VA to prevent injury among the 2,000 people it employs in skiing-related jobs.

The process itself is quick and painless. First, each employee fills out a questionnaire that includes information about his department, injury history, surgical history, exercise schedule and whether he skis or snowboards. Then he is examined by medical personnel, who perform two standard tests-the Lachman test, which measures anterior stability, and the Pivot-Shift exam, which measures lateral stability. In these hands-on tests, the physician checks the knees for “endpoints,” which indicate healthy, attached ligaments and stable knees. If either test reveals a red flag, then the employee undergoes a KT test, which determines the knee’s degree of instability. A highly unstable knee is said to be ACL deficient. Since people who are ACL deficient are about six times as likely to sustain an injury, those employees are then referred to a senior physician for a full-review and recommendations.

“There are lots of avenues to take before giving up the sport,” says Karen Briggs, director of clinical research for the Steadman-Hawkins Clinic. Of the employees who are ACL deficient, some are referred to a physical therapy program-usually a regimen of exercises prescribed by S.P.O.R.T., the rehabilitative arm of the Steadman-Hawkins Clinic. They are also advised to wear a custom knee brace while skiing. VA picks up the tab for both the therapy and the brace. (The brace alone costs about $1,000.)

Has it been worth it? When the program first started, 18 of Vail’s 2,000 on-snow employees suffered ACL injuries. Last season, that number dropped to 12. “It more than pays for itself,” says Les Marsh, Vail’s director of human resources. But just how much the company saves is difficult to track. Medical costs alone can be in excess of $20,000 per knee injury. That doesn’t include the ancillary costs of finding and training replacement workers.

The screenings have benefitted both employees and employer. “The ultimate way to prevent injury is to give people the tools to take care of themselves,” says Marsh. “Through increased education we reduce exposure.” By continuing with the knee evaluations, along with benefits such as free flu shots, health screenings and a wellness program, “We feel it’s a way to show we care,” says Marsh. Warm and fuzzy, yes, but Vail knows that a healthy, happy employee is a productive employee.

So how can you use this information if you don’t work in Vail? Your own doctor can perform the same simple tests to determine your knees’ stability. If you are ACL deficient, you can use the same intervention techniques that VA has used.

The Steadman-Hawkins Foundation is looking to expand its research by aiding studies that include a larger skier population. “We want our efforts to be more collaborative and less competitive,” explains Briggs. “By tracking the data, we can use it as an orthopedic research tool.” And while there’s still no cure for common knee injuries, as information is gained, there may be fewer tattoos on the slopes.

In 1996-97, skiers spent about the same amount of money on kneee surgery as they did on new skis.

Doing The Research
The Steadman-Hawkins Foundation’s findings provide information not only for Vail Associates, but for any skier who wants to prevent knee-related injuries.

Some factors that put you at higher risk: n Previous knee injury. Nearly half the injured skiers had experienced earlier knee injuries.

ACL deficiency. An ACL-deficient knee is six times as likely to sustain an injury.

Poor conditioning. Of those who sustained knee injuries, only one out of five had participated in a pre-season exercise program.

Twisting falls. Most injuries occurred during a fall with a twisted knee. Some tips for protecting yourself: n Have your knees checked by a specialist. If you determine that you are ACL deficient, consider a custom brace.

Get strong. Build general strength and focus on the muscles around the knee in a pre-season conditioning program.

Avoid twisting falls. Sitting back is also a high-risk position.

Check your equipment. By having your bindings properly adjusted, you have a far better chance of releasing when you should. For more information call Steadman-Hawkins at (970) 476-1100.