During my game last week I was hip checked on the outside part of my knee and it buckled. I have a lot of discomfort and swelling, but it’s on the inside part of my knee. I was told that I have a MCL injury by my school trainer. Doctor Hockey, when can I get back on the ice?
The Medial Collateral Ligament (MCL) is one of four main ligaments in the knee. It is the most frequently injured knee ligament in ice hockey. It attaches from the femur (thigh bone) down to the tibia (leg bone) on the inside part of the knee. The most common mechanism of injury is a collision causing an outside force on the knee which stresses and tears the MCL ligament. It can also be injured from catching a skate edge and sustaining a twisting force to the knee.
There have been a couple high profile NHL players with significant MCL injuries over the last couple of seasons including the Islanders’ John Tavares during the Sochi Olympics.
MCL Injuries are graded in severity. Grade I injuries are sprains that have a firm endpoint on exam, Grade II are partial tears and Grade III are complete tears of the MCL.
The general rule is that injuries to the femoral side of the MCL are more painful then tibial sided tears. Tibial
sided tears sometimes take longer to heal and need to be followed up closely. Finally, you should see a sports medicine physician with a MCL injury for a thorough physical examination to make sure you have not injured any other additional structures in the knee.
The typical treatment program for MCL injuries involve initially getting the pain and swelling under control. This is the time to use the (RICE) protocol of rest, ice, compression wrap and elevation of the injured knee. We recommend a hinged knee brace during this time period to provide stability and help promote earlier ambulation without a limp.
As soon as the hockey player can tolerate bending the knee with little pain and stiffness, the go to staple of the MCL
rehabilitation program is the stationary bicycle. This causes very little side to side force on the knee and is excellent for promoting motion and building back up quadriceps strength after this injury. This is also a good time to get in and work with the physical therapist on core muscle strengthening.
The general rule for return to play after MCL injuries is to multiply the grade of the injury by two and that’s how many weeks to expect to be out of play. Grade I injuries typically take 1-2 weeks, Grade II take four weeks and Grade III can take 6-8 weeks to return to competitive hockey.
In your case I would recommend taking an anti-inflammatory medicine like Naproxen (Aleve) twice a day, icing the knee three times a day for 20 minutes and seeing your physician for a hinged knee brace and physical exam. As soon as you are able, you should incorporate a stationary bicycle into your daily workout. Even if you had a Grade III injury, there is a good chance for you to be back on the ice within six weeks. I would however, recommend you play the rest of the hockey season in the hinged knee brace under your pads.
Lead physician at HockeyClan
Charles A. Popkin, MD is an Assistant Professor of Orthopedic Surgery at the Center for Shoulder, Elbow and Sports Medicine at Columbia University in New York. Dr. Popkin is currently conducting research on ice hockey injury prevention and has published on both youth and adult ice hockey injuries. A lifelong hockey enthusiast, Dr. Popkin has cared for college hockey teams in both Minnesota and Canada.
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