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In
October, with just a couple of runs open at the local ski resorts, Dr. Aaron
Black has already seen a patient who required 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
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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
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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.