Background: Skiing and snowboarding have become increasingly popular since the inception of the winter X-Games in 1997. Purpose: To determine (1) rate of return to sport (RTS) to the winter X-Games following anterior cruciate ligament (ACL) reconstruction and (2) performance upon RTS following ACL reconstruction. Hypotheses: There is a high rate of RTS to the winter X-Games in subjects undergoing ACL reconstruction. There is no difference in performance upon RTS following ACL reconstruction versus preinjury. Study design: Case series; Level of evidence, 4. Methods: Skiers and snowboarders competing in the winter X-Games who tore their ACL and underwent ACL reconstruction between 1997 and 2012 were evaluated. Athlete data were extracted from winter X-Games media websites, ESPN, injury reports, player profiles/biographies, and press releases. All athlete, knee, and surgical demographic data were analyzed. RTS and performance as it related to the number of gold, silver, and bronze medals won both pre- and postoperatively in the X-Games were analyzed. Results: Fifteen skiers (19 knees) and 10 snowboarders (10 knees) were analyzed. There were 13 males and 12 females, with a mean subject age of 22.6 ± 4.45 years. The rate of RTS in the X-Games following ACL reconstruction was 80% overall (20/25 subjects). The rate of RTS in winter X-Games following ACL reconstruction in skiers was 87% (13/15 subjects) and in snowboarders was 70% (7/10 subjects). The rate of RTS in winter X-Games following ACL reconstruction in males and females was 85% (11/13 subjects) and 75% (9/12 subjects), respectively. The rate of revision ACL reconstruction due to ACL tear following primary ACL reconstruction was 4% (1/25 subjects). There were more left- than right-sided tears (18 vs 11). Skiers and snowboarders competed in the X-Games for 3.84 ± 2.73 and 3.40 ± 2.84 years prior to ACL reconstruction and 2.56 ± 2.06 and 7.29 ± 3.30 years after ACL reconstruction, respectively. Skiers earned 22 medals prior to ACL reconstruction (9 gold, 5 silver, 8 bronze) and 24 medals after ACL reconstruction (16 gold, 2 silver, 6 bronze). Snowboarders earned 7 medals prior to ACL reconstruction (4 gold, 1 silver, 2 bronze) and 19 medals after ACL reconstruction (7 gold, 7 silver, 5 bronze). Conclusion: Winter X-Games skiers and snowboarders have a high rate of RTS after ACL reconstruction. Skiers earned a similar number of medals preinjury and postsurgery, while snowboarders earned more medals following surgery.
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