University of Vermont

College of Medicine

Vermont Medicine Magazine

Spring Snow Poses Opportunity to Reflect on Legacy, Future of Injury Clinic Research


In Vermont, the ski season doesn’t end until Mother Nature says so, and with this past week’s snowfall, skiers and snowboarders have an opportunity to enjoy the hundreds of trails at area resorts for a little longer. However, the fun these winter sports offer comes with some risk and sometimes, a visit to an injury clinic. That’s the point where a team of University of Vermont-affiliated researchers has played a major role for the past 40 years, but the future of their study is in jeopardy.

This group – including Robert Johnson, M.D., professor emeritus of orthopaedics and rehabilitation, Carl Ettlinger, M.S., adjunct assistant professor of orthopaedics and rehabilitation, and Jasper Shealy, Ph.D., professor emeritus at Rochester Institute of Technology – has collected snow sport injury data each winter since the 1972-73 season at a clinic located at Vermont’s Sugarbush resort. Their research constitutes the longest running and broadest study in the field, but as the original team members move towards retirement, the ability to continue the study is uncertain unless a new crop of orthopaedists and volunteers join the project.

The clinic, run by Fletcher Allen Health Care, treats and collects injury data from patients, as well as collects information from randomly selected uninjured skiers. The research team’s work has included studying injury tends; studying winter sports equipment’s effect on injuries and prevention; conducting in-depth studies of specific common injuries; and monitoring the rate of knee anterior cruciate ligament (ACL) injuries. Over time, this information has allowed the research team to identify trends and the factors that influence the risk of injury.

“Our project has had a major effect on what were once the most common skiing related injuries – fractures and sprains of the lower leg and ankle,” says Ettlinger, an engineer who has played a major role in the development of safety related equipment and training programs for ski areas and ski shops and the skiing public. “These injuries declined by 86 percent in the first 17 years of the study in response to improvements in ski equipment design and equipment service practices.”

According to Shealy, the team’s findings, published in numerous peer reviewed journals, became the scientific basis for U.S. and international standards down to the level of ski shop practices. To date, the reduction in the incidence of these lower leg injuries amounts to a savings of billions of dollars in medical expenses in the U.S. alone. 

“However, our greatest success,” Ettlinger points out, “ has been the determination that the risk of serious knee injury involving the ACL is not related to the release system.” Ettlinger runs Vermont Ski Safety, which provides safety related products and services to the snow sports industry.

He and the research team developed a free pamphlet – distributed online and at ski shops – titled “Tips for Knee-Friendly Skiing,” which is currently the only proven means to help skiers reduce the risk of ACL sprains. The video based research recorded a 55% reduction in the incidence of ACL injuries among ski area employees overall at 20 U.S. resorts, with a 75% reduction noted among ski patrollers.

The value of the team’s contributions has been recognized nationally and internationally, with dozens of interviews and articles in the lay media, including a recent Reuters News article and a December 2008 article in the New York Times.

Over the last 40 years the team, and their orthopaedics colleagues, have published more than 50 peer reviewed papers and books using data from the Sugarbush project.  Additionally, 16 volumes of the text Skiing Trauma and Safety (ASTM International), have been co-edited by Johnson, Shealy, and others since the 1980s. Johnson is the recipient of many honors, including the 2011 Distinguished American Award from the Vermont Chapter of the National Football Foundation, 2007 American Orthopaedic Society of Sports Medicine Hall of Fame, 2006 Hughston Award from the American Orthopaedic Society for Sports Medicine, and three O’Donoghue Research Awards from the American Orthopaedic Society for Sports Medicine (1983, 1996 and 2005).