Feature Story
The Hockey Doc on lateral collateral knee
injuries
By Dr. Rob LaPrade,
M.D., Ph.D.
Let’s Play Hockey Columnist
QUESTION: I got checked from the
inside of my left leg and felt a pop. I was told that I have a partial tear of
my lateral collateral ligament. How long will this take to heal, and what do I
need to do to get back sooner?
ANSWER: The type of injury that you
have is an injury to the ligament on the outside of your knee. These are much
less common than medial collateral ligament injuries, because most on-ice
contact injuries happen when you are hit on the outside of your knee rather
than the inside. What happens is that the ligaments are damaged on the side
opposite of where you were hit because they can be stretched or torn on that
side.
The lateral, or fibular, collateral ligament is a very
important structure to prevent one’s knee from feeling unstable in side-to-side
activities. This is especially true in hockey players, who are often
bow-legged. When they put their foot down, they are putting more weight through
the inside part of their knee, which causes the outside to have more stress on
it. If the lateral collateral ligament is torn, the knee can gap open and make
it very difficult in any type of push off or striding activities toward the
injured side.
Probably the most important thing about the lateral collateral
ligament is that when it’s completely torn it usually does not heal. Thus, it
is almost the exact opposite in its natural history compared to medial
collateral ligament injuries on the inside of the knee which almost always
heal. Therefore, it is very important to determine if there is a complete tear
of this ligament using a good clinical exam,
In your case, where there appears to be a partial tear,
it is important to give the ligament some time to heal prior to putting
significant stress on it, or it could heal in an elongated position and you
could have some residual instability problems. We usually recommend that
athletes be braced for 2-3 weeks with no significant twisting, turning, or
pivoting activities to make sure that this ligament heals.
For high level athletes, we usually recommend the use
of a custom made medial compartment unloader brace,
which in effect pushes the knee towards the outside, for the first 6-8 weeks
after partial tears, to protect the ligament from going on to a complete tear.
While it is possible that a well-fitted hinged knee brace may be effective, we
believe that the use of the unloader brace
significantly minimizes the risk of re-injury.
In your case, it is important that you work on
maintaining your endurance without any significant side-to-side activities
prior to going back to any on-ice activities. If you wish to return to on-ice
activities in the first six weeks of your injury, it would be strongly
recommended that you use an unloader brace for the
first 6-8 weeks to minimize your chance of re-injury.
Dr. Rob LaPrade,
MD, PhD, is the team physician for the