Introduction & Aims: Injury to the Anterior Cruciate Ligament (ACL) is overrepresented in alpine skiing injuries and is 365 times higher compared to general population risk. Methods of ACL injury in skiing are known yet technology that could respond to this and protect the ACL have not been commercially developed. The aim of this study is to highlight injury methods and ski binding technology that may protect the ACL. Method: An extensive literature review was conducted to investigate ACL rupture incidence in alpine skiing along with mechanisms of injury. Medline and PUBMED databases were searched. Mechanisms of binding function were studied and variations in binding technology were noted along with variations in modern ski technology (shape and length). Intervention strategies to potentially prevent ACL injury were studied. Results: ACL rupture incidence in alpine skiing has not change in 30 years. The modern ski/ski binding has reduced the number of leg injuries but not that of ACL rupture. Studies looking at various ski lengths and shape, binding settings, boot stiffness and education programs have had inconsistent results in reducing ACL rupture incidence. Several binding "new technologies" have been developed that will respond to the unique biomechanical environment in skiing that causes ACL rupture. These bindings have not been marketed for commercial reasons. The ski industry has technology that could reduce the ACL rupture incidence universally across all standards of alpine skier. Conclusions: National and International orthopaedic/medical associations need to be proactive in encouraging the ski industry to exploit technology that will prevent ACL rupture incidence. Such organizations have been proactive elsewhere in trauma, for example, encouraging helmet use in cycling. The opportunity to reduce serious knee injuries in alpine skiing similarly exists and should be acted upon.
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