Imagine the ski racer doing his daily inventory: Skis? Check. Boots? Check. Poles, helmet, goggles? Check, check and check. Reconstructed anterior cruciate ligament? Of course.
In Alpine racing, tearing an ACL has become a rite of passage. With one exception every American skier who medaled at the Olympics or world championships between 1976 and 2001 has had either a torn ACL or another major knee injury. (Daron Rahlves, who won the Super G at the '01 worlds with two healthy knees, has a lengthy history of other injuries that includes two dislocated hips.) Downhiller Picabo Street, a two-time Olympic medalist, is the queen of reconstruction. Her left knee has been done twice, once only 14 months before she won the Super G gold in Nagano, and her right knee was done shortly after those Games.
Years ago skiers raced on wooden planks in ankle-high leather boots, and broken legs were common. Now—as skiers compete on superfast fiberglass skis and wear much higher, stiffer boots—torn ACLs have become the dominant injury, because "the knee is the fulcrum for all of the pressure," says orthopedic surgeon Richard Steadman of Vail, Colo., who has performed the vast majority of ACL surgeries on top U.S. skiers in the last 29 years. When world-class ski racers lose their balance and try to recover at high speed or carve slalom turns at severe angles to the snow, the twisting action that takes place between the tibia (lower leg) and femur (upper leg), atop a relatively stationary ankle, can shred the ACL.
In racers the ACL tear is often just the first in a chain reaction of injuries that results from a loss of control at high speed. When Street tore her right ACL during a race in Switzerland after the Nagano Games, she also shattered her left femur and suffered cartilage damage. The ACL tear may have caused Street to lose control, then fly sideways into safety netting.
Recuperating Steadman patients like U.S. downhiller Chad Fleischer, who tore his ACL and other right knee ligaments while training in Switzerland last month, should have cause for hope as they watch the Salt Lake Games: It's likely that the vast majority of skiers who step onto the medal stand there will do so on reconstructed knees.