ACL injuries in elite alpine skiing reliably allow athletes to return to competition and perform at or above their pre-injury level

Purpose: Anterior cruciate ligament (ACL) injuries are frequently observed in alpine skiing. However, available data regarding post-injury performance levels remain scarce. This study aimed to investigate whether ACL injuries in elite-level alpine skiers limit performance levels after ACL reconstruction (ACLR). Methods: Male and female elite-level alpine skiers from national A-teams who sustained an ACL injury were retrospectively identified through media reports and the Fédération Internationale de Ski database, across all disciplines (downhill, super G, giant slalom and slalom [SL]). World Cup (WC) results and time out of competition before injury and after ACLR were analyzed. Inclusion criteria were injury during or after the 2003/2004 season and participation in at least one WC event pre-injury. Performance levels from two seasons before the injury through the 2022/2023 season were assessed. Results: Forty-eight elite alpine skiers (28 males and 20 females) met the inclusion criteria. Of these, 97.9% returned to professional competition after ACLR. One female athlete had not yet returned due to a recent injury. The mean return-to-competition (RTC) time was 11.9 ± 4.5 (range: 7–25) months for males and 11.3 ± 1.8 (8–16) months for females. Post-ACLR, athletes demonstrated similar or improved mean WC placements, regardless of discipline. A decline in performance was observed only in SL. A corresponding trend was observed in the top three placements following ACLR. Among skiers returning to competition, 80.8% of males and 63.1% of females reached their pre-injury performance levels. Athletes with multiple injuries or nonoperative treatment showed variable outcomes. Conclusion: Elite alpine skiers can successfully return to WC competition following ACL injury, with many reaching or surpassing pre-injury performance. Performance variability underscores the need for individualized therapy and rehabilitation to optimize recovery in this specific population. Level of Evidence: Level IV.