Feature Story

Feature Story

The Hockey Doc on ACL tears

By Dr. Rob LaPrade

Question: I injured my knee playing intramural basketball and my trainer tells me that I have torn my anterior cruciate ligament. I am a senior and this is my last chance to play competitive hockey. Is it safe for me to continue to play hockey this year, or should I have my ligament reconstructed now?

Answer: This is a very difficult question because there is no exact answer for it. I believe the best answer resides in knowing all the facts, consulting with your family, and making a decision based on the understanding of this information.

It is generally believed that one does not need an anterior cruciate ligament (ACL) for skating. Some hockey players can compensate for a torn ACL and skate quite effectively for a while. No matter what, it is generally accepted that a hockey player have their ACL reconstructed once their season is completed.

An ACL tear is one of the most common ligament injuries that we see in sports medicine. The ACL is essential to providing stability about the knee for any type of twisting, pivoting, or cutting sport.

When an athlete is ACL-deficient, the knee can actually sublux or partially dislocate with a significant twisting episode. Every time this happens, either the cartilage at the end of the bone or one of the menisci can be torn.

About 70 percent of people who are ACL deficient will develop arthritis in their knees by 10 years after their injury and arthritis can develop from these repeated episodes of injury.

Athletes who play twisting, turning or pivoting sports with an ACL tear and wait until after the season is completed to have their reconstruction frequently have significant injuries from the joint slippage. More than 50 percent of these athletes have been found to have sustained an injury to either their articular cartilage or the meniscus. Since one of the main goals of an ACL reconstruction is to prevent injuries to these other structures of the knee, it is very frustrating to sustain this type of injury, which has long term consequences, when it could have been prevented.

I think you should make a careful assessment of your goals prior to choosing to undergo rehabilitation, bracing and returning back to ice hockey versus choosing an ACL reconstruction with a certainty of losing between 5-7 months of on-ice activities and competitive sports activities.

While in the majority of circumstances I would recommend early ACL reconstruction to stabilize the knee and to prevent injuries to other important structures, a properly rehabilitated athlete who avoids any off-ice activities which involve twisting, turning or pivoting does have a relatively small risk of injuring other structures of their knee by returning back to playing hockey.

In your case, I would recommend that you talk to your parents and team physician and choose what you feel is the best option for you.

Dr. Rob LaPrade, MD, PhD, is the team physician for the University of Minnesota men’s hockey team and a professor in the Department of Orthopaedic Surgery at the University of Minnesota. If you have a question for the Hockey Doc, send it to 2721 East 42nd Street, Minneapolis, MN 55406, fax it to 612-729-0259 or e-mail it to editor@letsplayhockey.com.