Hockey Doc

The Hockey Doc: MCL injuries

By Dr. Rob LaPrade
http://drrobertlaprademd.com

Question: During my last game I was hit on the outside of my leg and immediately had pain on the inside of my knee. I was told that I have a Grade II MCL tear. What can I do to get back to the ice?

Answer: It appears that you have partially torn the medial collateral ligament, also called the MCL. The MCL is one of the strongest ligaments in the body. It is on the inside of the knee and attaches the tibia to the femur. It is most commonly injured when a skater sustains a direct contact injury to the outside of their knee which stresses and ultimately tears the ligaments on the inside of the knee.

 

It is also common to catch an edge and injure one’s MCL. Injuries to ligaments such as the MCL are graded I, II and III. Grade I injuries are mild sprains, while grade II are partial tears to the MCL. Complete tears to the MCL are grade III. Luckily, most players with MCL injuries make a complete recovery without surgery once they have been properly rehabilitated. However, MCL tears off of the tibia sometimes do not heal and need to be monitored more closely. It is also important for knees with MCL injuries to be thoroughly examined to make sure there are no other injuries present that would change the treatment plan.

Our treatment protocol for these injuries at The Steadman Clinic has been developed based upon basic research and the results that we have seen in high-level athletes. As with any initial injury, the initial treatment consists of a RICE protocol (Rest, Ice, Compression and Elevation). It is essential to minimize the swelling in your knee as much as possible, because this allows a quicker return to on-ice activity. Ice, applied approximately 20 minutes out of each hour, is important within the first 48 hours of injury because it constricts the nearby blood vessels so there is less swelling in the injured area. A compression wrap or elastic sleeve will also help to decrease swelling for the first few days after injury. In addition, we occasionally use a hinged knee brace for these injuries to provide some stability to the healing ligament in grade 2 and 3 tears. Full weight bearing is allowed but crutches should be used until one can walk without a limp.

Once the initial phase of treatment is completed, further treatment should be started with the aim of getting you back to competition as soon as possible. Quadriceps setting exercises, where the quadriceps muscles are tightened similar to how they would be tightened if you performed a straight leg raise, with the muscles held tight for 6-8 seconds, can be performed hourly starting immediately after injury. Leg raises can also be initiated immediately. It is important to start these exercises as soon as possible to prevent quadriceps muscle weakness.

Once the knee can be bent without a lot of pain or stiffness, which is usually within 1-3 days, you can get on an exercise bike. Exercise biking is safe for MCL injuries because it puts very little sideways stress on the knee, and early, repetitive cycling has been shown to help MCL tears to heal. We place our skaters on a stationary bike as soon as they can tolerate it and increase their time and resistance on the bike gradually to minimize swelling in the knee.

Skaters should be followed closely and monitored for advancement in their rehabilitation. They may return back to competition once they have regained full strength, have no swelling of their knee, and have evidence of MCL healing on physical exam. The general time frame we find for a return back to competition is 1-2 weeks for grade I tears, 3-4 weeks for grade II tears, and 4-6 weeks for grade III tears.

In your case, I would first recommend that you make sure all of your swelling and pain are under control. You should then get on an exercise bike and work hard to regain your overall strength. If you have any trouble at any stage of your rehabilitation, you should check back with your team trainer or physician for reassessment to make sure there are no other associated injuries present. If all goes well, you could be back on the ice within a month.

Robert F. LaPrade, M.D., Ph.D. is a complex knee surgeon at The Steadman Clinic in Vail, Colorado.  He is very active in research for the prevention and treatment of ice hockey injuries. Dr. LaPrade is also the Chief Medical Research Officer at the Steadman Philippon Research Institute. Formerly, he was the team physician for the University of Minnesota men’s hockey team and a professor in the Department of Orthopaedic Surgery at the U of M. If you have a question for the Hockey Doc, e-mail it to This email address is being protected from spambots. You need JavaScript enabled to view it..