Ordination Dr. Maximilian Kasparek
MK Orthopädie Währing
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22. January 2026

Ski in­jury: ACL tear & ACL reconstruction

Ski in­jury: ACL tear – when is ACL re­con­s­truc­tion advisable?

A twis­ted ski, a deep fall, or an un­fort­u­nate im­pact while ski­ing or snow­boar­ding – and sud­denly the knee is unsta­ble, pain­ful, and swol­len. One of the most com­mon and con­se­quen­tial ski in­ju­ries is a tear of the an­te­rior cru­ciate li­ga­ment.

Espe­ci­ally du­ring al­pine win­ter sports, high forces act ab­ruptly on the bent knee, ma­king the cru­ciate li­ga­ment par­ti­cu­larly vulnerable.

But what to do if the ACL tear hap­pens du­ring a win­ter va­ca­tion? Is im­me­diate sur­gery ne­ces­sary? And when is ACL re­con­s­truc­tion (ACL plasty) advisable? 

First aid on the slo­pes: How to re­act cor­rectly if an ACL tear is suspected

An ACL tear usually oc­curs due to a sud­den twis­ting mo­tion in the knee with the foot fi­xed. Those af­fec­ted of­ten re­port an au­di­ble or no­ti­ceable “crack,” fol­lo­wed by in­sta­bi­lity and ra­pid swelling. 

You should do the following:

  • Stop im­me­dia­tely and do not put any fur­ther strain on the knee
  • Do not ski to the val­ley yours­elf if you ex­pe­ri­ence in­sta­bi­lity or se­vere pain
  • No­tify the ski pa­t­rol or res­cue service
  • Ele­vate, cool, and im­mo­bi­lize the knee

Con­ti­nuing to ski de­spite in­sta­bi­lity can cause ad­di­tio­nal da­mage to the knee.

Cla­ri­fi­ca­tion in the hos­pi­tal: MRI and in­itial assessment

In the hos­pi­tal or ac­ci­dent out­pa­ti­ent cli­nic, a cli­ni­cal ex­ami­na­tion and usually an MRI are per­for­med. This shows whe­ther there is a par­tial or com­plete ACL tear and whe­ther there are any ac­com­pany­ing in­ju­ries such as me­nis­cus, la­te­ral li­ga­ment, or car­ti­lage damage. 

Not every ACL tear re­qui­res im­me­diate sur­gery. In many ca­ses, fur­ther care can be plan­ned and car­ried out af­ter re­tur­ning home. 

Im­me­diate sur­gery is only ra­rely ne­ces­sary, such as in ca­ses of:

  • mas­si­vely unsta­ble knee
  • blo­cked joint
  • pro­no­un­ced con­co­mi­tant injuries
ACL re­con­s­truc­tion (ACL plasty): Pro­ven stan­dard for unsta­ble tears

In the vast ma­jo­rity of ca­ses, a torn an­te­rior cru­ciate li­ga­ment is re­pla­ced by me­ans of ACL re­con­s­truc­tion. The de­s­troyed li­ga­ment is re­pla­ced with the bo­dy’s own ten­don graft, which is in­ser­ted and fi­xed arthroscopically. 

When is ACL re­con­s­truc­tion advisable?

  • in case of si­gni­fi­cant knee instability
  • in case of com­plete ACL tears
  • for ath­le­ti­cally ac­tive patients
  • in case of com­bi­ned in­ju­ries (e.g., me­nis­cus, cartilage)

ACL re­con­s­truc­tion is a long-es­tab­lished pro­ce­dure with high sta­bi­lity and good long-term re­sults – espe­ci­ally for peo­ple who want to be able to do sports safely again.

Af­ter the ski va­ca­tion: What hap­pens next?

Af­ter re­tur­ning, an ap­point­ment should be made promptly with a prac­tice spe­cia­li­zing in knee in­ju­ries. There, the in­jury will be as­ses­sed again in de­tail and a joint de­cis­ion will be made as to which the­rapy is appropriate. 

The­rapy options:

The the­rapy de­cis­ion is al­ways ba­sed on sta­bi­lity, ever­y­day stress, and ath­le­tic goals.

Con­clu­sion: ACL tear af­ter a ski in­jury – well treata­ble with a clear strategy

An ACL tear is a se­rious ski in­jury, but it can be trea­ted very well today.
With ra­pid first aid, tar­ge­ted dia­gno­stics, and in­di­vi­du­ally tail­o­red the­rapy – con­ser­va­tive or sur­gi­cal – there are very good chan­ces of achie­ving a sta­ble and re­si­li­ent knee joint again.

Fre­quently As­ked Ques­ti­ons (FAQ)

What does an ACL tear feel like?

Ty­pi­cal is a sud­den gi­ving way of the knee, of­ten ac­com­pa­nied by a “crack” or tear in the joint. Wi­thin a short time, the knee usually swells si­gni­fi­cantly be­cause there is an ef­fu­sion in the joint. Many af­fec­ted in­di­vi­du­als re­port a pro­no­un­ced fee­ling of in­sta­bi­lity, espe­ci­ally when wal­king or turning. 

Does every ACL tear re­quire sur­gery?

No. Not every ACL tear re­qui­res sur­gery. For sta­ble par­tial te­ars, low ever­y­day or sports stress, or good mus­cu­lar gui­dance of the knee, con­ser­va­tive the­rapy with tar­ge­ted phy­sio­the­rapy may be suf­fi­ci­ent. The cru­cial fac­tor is whe­ther the knee re­mains sta­ble in ever­y­day life and un­der stress. 

What is ACL re­con­s­truc­tion?

Du­ring ACL re­con­s­truc­tion, the torn an­te­rior cru­ciate li­ga­ment is re­pla­ced with the bo­dy’s own ten­don graft. The goal of the pro­ce­dure is to per­ma­nently res­tore the sta­bi­lity of the knee joint and avoid con­se­quen­tial da­mage. The pro­ce­dure is mi­ni­mally in­va­sive and is now an es­tab­lished stan­dard procedure. 

What is ACL re­fix­a­tion?

Du­ring ACL re­fix­a­tion, an at­tempt is made to pre­serve the torn cru­ciate li­ga­ment and re­at­tach it to the bone. This me­thod is only an op­tion in very sel­ec­ted ca­ses, such as fresh, bone-close te­ars with good li­ga­ment qua­lity. Whe­ther this pro­ce­dure is pos­si­ble must be de­ci­ded individually. 

How long does re­ha­bi­li­ta­tion take af­ter ACL re­con­s­truc­tion?

Re­ha­bi­li­ta­tion ta­kes se­ve­ral months. In the first few weeks, the fo­cus is on mo­bi­lity, swel­ling re­duc­tion, and mus­cle ac­ti­va­tion. This is fol­lo­wed by tar­ge­ted strength, coor­di­na­tion, and sta­bi­lity trai­ning. The re­turn to sport ta­kes place gra­du­ally and in­di­vi­du­ally adapted. 

Can I ski again af­ter an ACL tear?

Yes. Af­ter suc­cessful tre­at­ment and com­ple­ted re­ha­bi­li­ta­tion, a re­turn to ski­ing is pos­si­ble in most ca­ses. Pre­re­qui­si­tes are a sta­ble li­ga­ment re­pla­ce­ment, suf­fi­ci­ent mus­cle de­ve­lo­p­ment, and good coor­di­na­tion. The exact time will be de­ter­mi­ned individually. 

When should I see a doc­tor af­ter my va­ca­tion?

Af­ter a knee in­jury on a ski va­ca­tion, a spe­cia­list me­di­cal ex­ami­na­tion should be car­ried out as quickly as pos­si­ble – ide­ally wi­thin a few days. Early dia­gno­sis fa­ci­li­ta­tes the­rapy plan­ning and helps to avoid ad­di­tio­nal damage. 

Are there long-term con­se­quen­ces if an ACL tear is not trea­ted?

Yes. An unt­rea­ted ACL tear can lead to per­ma­nent in­sta­bi­lity. This si­gni­fi­cantly in­crea­ses the risk of me­nis­cus and car­ti­lage da­mage, as well as pre­ma­ture os­teo­ar­thri­tis of the knee joint. 

Did you have a knee in­jury while ski­ing or su­spect an ACL tear?

In my pri­vate prac­tice in Vi­enna, we cla­rify the exact dia­gno­sis and dis­cuss tog­e­ther whe­ther ACL re­con­s­truc­tion or con­ser­va­tive tre­at­ment is appropriate.
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Maximilian Kasparek, MSc
haelsi Gesundheitszentrum im Achtzehnten Theresiengasse 46/2 1180 Vienna

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