In the early ski season with just a couple of runs open at the local ski resorts, Dr. Aaron Black says it’s already common to see patients who require surgery due to an on-mountain injury.

“We see common sports-related orthopedic injuries, as well as more trauma-related injuries,” said Dr. Aaron Black, an orthopaedic surgeon specializing in sports medicine at Panorama Summit Orthopedics. “When it comes to skiers, it’s generally their knees that get injured. Everyone knows somebody who’s torn an ACL.”

Through knee reconstruction, repair and replacement surgeries, cartilage restoration procedures and other sports medicine treatments, Dr. Black — an avid skier himself — finds great satisfaction in returning outdoor enthusiasts and athletes back to their beloved activities. With ski season upon us, here are some of the things Dr. Black wants skiers and snowboarders to think about. 

Common skiing and snowboarding injuries

The most common reason for skiers and snowboarders to end up at Panorama Summit Orthopedics is due to ACL (anterior cruciate ligament) and MCL (medial collateral ligament) injuries, both in the knee.

“Those two injuries often come together because of the dynamic forces that happen during the most common ways people fall,” Dr. Black said.

Another common injury in skiers and snowboarders is a meniscus tear. Meniscus is a small piece of cartilage that provides a cushion between the femur and tibia. 

“Meniscus is very important because it protects your cartilage,” Dr. Black said. “I’m very aggressive about fixing meniscus — if I can save it, I save it.”

A less common, but still familiar, skier injury in Summit County is a tibial spine avulsion fracture, which Dr. Black said usually happens when the knee hyperextends during a rotation. This is equivalent to an ACL tear but tends to heal much faster with appropriate surgical treatment. 

There are two common mechanisms that cause the ACL to tear. The first one is when people lean far back in their skis, it lets the tibia slide forward, which is one of the forces the ACL resists. This is more common with beginners and those who are tired at the end of a long day Dr. Black said.  The second is a so-called dynamic snowplow injury, the front edge of the ski catches and keeps rotating inward.

The importance of pre-season conditioning 

Dr. Black has a special appreciation for pre-season conditioning — he used to work as a certified physical trainer, and he also participates in a diverse mix of sports and activities himself. 

“I have my own ski conditioning program I am doing now to get ready for the season,” he said. “A lot of what we do in the summer doesn’t prepare us well for the ski season. It prepares us well cardiovascularly to go out and ski all day, but not for the specific forces in skiing and snowboarding.”

Unless you’re cutting and pivoting a lot, like in soccer, most summertime sports are more straight-line motions. 

“What we lack is active side-to-side plyometric motions,” Dr. Black said, adding that this often results in quad-to-hamstring imbalances. “It’s very important your hamstrings are as strong as they need to be — it’s a supportive structure for the ACL.”

It’s also important to make sure your gear is dialed in before you head out on the hill. One thing Dr. Black makes sure to check is his binding release settings. 

“If your binding isn’t going to release, your ACL will,” he said. 

Realistic progression

Beginning plyometric exercises about four to six weeks before you start skiing or snowboarding is a good window for an already fit person, Dr. Black said. For someone with less frequent athletic training, it’s important to be honest with yourself about your capabilities and limitations — especially if you’re coming to Summit County from your couch back at sea level.

“The better strength and endurance you have going into ski season, the better you protect your body’s structures,” he said. “I’m a big fan of things you can do at home, such as plyometric and body-weight exercises that get your muscles woken up.”

Treating injuries

When an ACL tears, it’s almost always going to require surgery, Dr. Black said. The type of surgery and the recovery period depends on several factors. 

“Some ACLs can be repaired, while others need to be reconstructed. If I can repair it I will — if you can keep your own tissue, the recovery is faster,” he said. “Muscles try and protect the knee when it’s at risk or under stress, but that function doesn’t come back for about one to two years after reconstruction surgery. In repair surgery, it comes back immediately.”

Dr. Black has many techniques to fix cartilage injuries, including cartilage transplants. These restoration procedures are important because cartilage can’t regenerate itself. Cartilage restoration is a very complex procedure with very specific indications. It can have a dramatic positive impact on pain and confidence in your joints. The most common symptoms are persistent pain in a localized area around the knee that sometimes includes a catching sensation. A clinical evaluation is needed to see if the procedure is appropriate for your individual injury.