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The ACL Study Group meets every two years to update the latest knowledge on ACL injuries and treatments. This year’s meeting was at the base of the Hahnenkamm ski race in Kitzbuhel Austria—the most famous downhill ski race on the World Cup circuit. One hundred and fifty of the world’s top ACL surgeons watched 30 of the world’s bravest ski racers hurtle down the ice-crusted hill at 140 km/h (84 mph). The outcome of the race was predictable: The Austrians dominated. The outcome of the scientific meeting, however, was less conclusive; the ACL is still a tough problem to solve.

When a major injury occurs, the joint swells. Part of the swelling is good, and part is bad. Let’s look at what can be done to optimize the outcome.

Ski bindings have not substantially changed in decades. But skis and ski boot soles have, and therein lies the danger. Many bindings no longer work with all ski boots, and there is a growing mismatch between binding design and ski performance.