In the Olympic Winter Games, aerial skiers and pairs skaters aren't the only things that soar. Orthopedic injuries can be expected to hit record highs as well.

Alpine and freestyle skiers and snowboarders face the highest rates of injuries among their snow sport peers, and injury incidences in those fields have risen sharply in recent years.

In Beijing 2022, which kicked off Friday, Feb. 4^th, unfavorable weather conditions and a near total reliance on artificial snow portend similar, if not worse, trends.

To help us dig into the numbers on orthopedic injuries and winter sports a bit deeper — and discuss recent advances in orthopedic surgery that can help elite athletes get back to the top of their game faster — we asked sports enthusiast and Houston Methodist orthopedic surgeon Dr. Korsh Jafarnia for his take on what to expect at Beijing this year.

Q: What does available research tell us about injuries at the Winter Games?

One of the most comprehensive studies about the topic came out of China last year. It found the highest injury incidence rates at the three most recent Winter Olympics (Pyeongchang, Sochi and Vancouver) were in alpine skiing, snowboarding and freestyle skiing. The rates were on average 55% higher in the three sports than the rates were in earlier Winter Games.

Luckily, although injury rates have increased, severity hasn't necessarily followed suit. The most common injury types were joint and ligament injury (41.5%), fracture and bone bruises (24.4%), concussion (11.1%) and muscle/tendon injury (10.7%), according to the study. And the most common severely injured body parts were the knees (29.9%), head and face (12.1%), shoulders and clavicle (10.5%) and lower back (8.9%).

Aerial skiing, a subset of freestyle skiing, had the highest rate of injury, according to another study, with 49% of all competitors in 2014 sustaining an injury. Snowboardcross had the second-highest rate at 35%. Overuse injuries increased substantially from 2010 to 2014, from 31 to 76. Injuries caused by contact with a stationary object — including the ground — decreased from 115 in 2010 to 79 in 2014.

Q: What surprised you the most from the research you read?

I was surprised by how high the rates of injury were. Overall, around 11%-12% of all Winter Olympics participants sustain injuries. That's high. By comparison, among the general population, there are around two injuries reported per 1,000 ski visits.

I also was surprised that athletes are most likely to get injured during official training at the Winter Olympics, as opposed to during the competitions themselves or during training that takes place the rest of the year. Nobody really thinks about the warm-up sessions being more dangerous than the main event, but I suppose that's when they're getting used to the new terrain and trying to figure out what they can achieve before the medals are on the line.

I was not surprised by how many knee injuries there are. That's what I expected to see. But it did surprise me to see how many concussions there are. That was the second most common injury type, and that's a little worrying. There's still so much we don't know about how severe concussions are or aren't. The high rate of speed, velocity and impact — if things go wrong in these winter sports, it's not just your athletic career but your life or severe brain or spinal cord injuries you're worrying about.

Q: Have there been any recent advances in the way orthopedic injuries are treated that might relate to the Winter Olympics?

There are a lot of new techniques to get better constructs in the repair and reconstruction phase of injuries so that patients can get back to their sport faster.

There are certain anchor materials and techniques that work better. Some are even absorbable so that they go away over time and your own tissue takes over for the prosthetic. There are less invasive ways of repairing tissues, joints and even fractures. Instead of a big incision, you can make a small one, resulting in less tissue damage, faster healing and less inflammation.

And then a big trend with all elite athletes is augmenting ligament repairs with stronger and better materials — very stout suture tapes that help protect the repair while it's healing. It helps get patients back to their training faster, frequently in half the time.

Q: What do you expect we'll see as far as injury rates this year?

What we've seen in past trends is that Winter Olympics are relying more and more on artificial snow, because weather patterns are becoming more unpredictable. It's more difficult to keep the conditions at the optimal level for these sports. And that's a problem because, as the research shows, they are dangerous even in best weather conditions.

I think many athletes and coaches are concerned about injuries this year because of the 100% reliance on artificial snow. It's different from what these athletes are used to training on, and that alone could make it more dangerous. I am very hopeful that these fears will turn out to be unfounded.

Q: As someone who treats elite athletes, what are your thoughts on what the Olympics represent?

I think it's the pinnacle of all sports. It's what every athlete strives to get to. Especially every athlete under a certain age. (Eventually most of us give up on our Olympic dreams when we hit 40 or 50 or so.)

I really admire the grit and tenacity of the athletes. Not just in training so hard for so much of their life, but because they really don't give up — ever. Even with serious injuries that would've sidelined them in the not so distant past. I think you can attribute that, in part, to advances in orthopedic science and other training best practices. But it's also the determination of the athletes, who see injuries and other setbacks as challenges to overcome, not dream-busters. And I think there's a lesson we can all take out of that.