In the die-hard ski community it has been said that you’re not a real skier until you have ruptured your anterior cruciate ligament (ACL). While this might be over-stepping the mark a little, there is no doubt that the rate of ACL ruptures in skiers is quite high. Invariably an ACL rupture occurs after a fall or twist when the ski did not release from the binding. A ‘pop’ or ‘crack’ may be heard or felt I the knee. The injury is often not as painful as people expect, which sees many people not to seek medical attention and live their lives with ACL-deficient knees, without being aware of them. You will often hear people refer to their knee being ‘weak’ since they had an injury several years before.

Australia’s founding father of ACL reconstruction surgery, Merv Cross, often refers to the feeling of an ACL rupture as ‘nothing, nothing, something’. In other words the knee can feel quite normal and pain free and then give-way and buckle when you least expect it. The level of instability a person feels, along with the age and future sporting goals are the main factors used to decide whether to operate or not.

There is debate about the correct ISO binding settings to set people at whilst skiing. It is a difficult challenge to get the correct level that will protect against lower leg fractures, while still protecting the knee and not releasing when you don’t want it to. The poor technicians in the ski hire shop walk a tightrope with every rental. There have been many discussions on changing the mechanism of release in bindings to reduce the number of knee injuries without an increase in the number of injuries from inadvertent release.

One of the leading ‘ACL-preventive binding is simple called the Knee Binding was been developed by Rick Howell and his team from Stowe, Vermont, USA. Rick was previously responsible for inventing toe clip pedals for cycling. The key to the success of the device was the development of a new method of release that would identify when the fall is going to cause excess force on the ACL. Studies have shown that traditional ski bindings could not detect (and therefore respond) to these forces whereas the Knee Binding could – and crucially at force levels well below those that would lead to ACL rupture. At this stage the up-take of this new binding is still low, but hopes are high it will become the next generation of ski bindings.