Injury patterns in alpine skiing have changed over time as ski, boot, binding, and slope-grooming technologies have evolved. We retrospectively examined injury patterns in alpine skiers over a 9-year period at the Mammoth and June mountains (California) ski area. A total of 24,340 injuries were reported for the 9 seasons studied, and total lift tickets sold numbered 9,201,486. The overall injury rate was 2.6 injuries per 1,000 skier days and increased slowly over the period studied. The knee was the most frequently injured area at 35% of all injuries. Increasing trends (P < .05) were noted for the rates of lower extremity injuries (37%) and knee injuries (45%). A decreasing trend was noted for the rate of lacerations (31% decrease). Slight increases were noted in upper extremity and axial injury rates. Skiing injuries continue to be a worrisome recreational problem despite improvements in ski equipment and slope-grooming techniques. The increasing trend in lower extremity, particularly knee, injury rates highlights the need for continued skier education and equipment innovation.