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This article reviews the epidemiology of alpine ski racing–related injuries, risk factors, mechanisms of injury, and injury prevention strategies.Pertinent literature from peer-reviewed publications from 1976 through 2018.Clinical review.Level 5.The rate of injury in alpine ski racing is high. In general, knee injuries are the most common, with anterior cruciate ligament (ACL) disruptions being the most significant in terms of time loss from sport. Three specific mechanisms of ACL injury in alpine ski racers have recently been described (slip-catch, dynamic snowplow, and landing back-weighted). In contrast to other sports, female ski racers are not clearly at greater risk for ACL injury, especially at the highest level of competition. A high percentage of ski racers are able to return to their previous level of competition after ACL injury. Risk factors for injury and methods of injury prevention have been proposed; however, the rate of injury, particularly ACL injuries, has not decreased significantly.Alpine ski racing has a high injury rate. ACL injuries in particular remain problematic. Further study is needed to identify modifiable risk factors and implementation of injury prevention strategies.