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How to Recover From An MCL Injury A S K D R . H O C K E Y 46 // SEPTEMBER 2023 USAHOCKEYMAGAZINE.COM The above image is from an MRI displaying an MCL tear. As soon as you can tolerate bending the knee with minimal pain and stiffness, you can begin exercising on a stationary bicycle. This central component of the MCL rehabilitation program promotes a repetitive cycling action that causes very little side-to-side force on the knee. It is excellent for improving range of motion and reducing swelling, thereby helping MCL tears to heal. The amount of time spent away from the rink depends on the grade of the MCL injury. The general rule for return to play is to multiply the grade of the MCL injury by two to get the number of weeks you will be out of play. Grade I injuries typically take up to two weeks to heal, and Grade II injuries will keep you off the ice for about four weeks. Plan on six weeks before returning to competitive hockey after a Grade III injury. 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 sports medicine physician for a proper knee exam and to obtain a hinged knee brace. As soon as pain and swelling are minimal, you should incorporate a stationary bicycle into your daily workout. Once you are back on the ice after a grade II or III injury, I recommend playing the rest of the hockey season with the hinged knee brace under your shin pads. Even if you had a Grade III injury, there is a good chance you will be back on the ice within six weeks. P Charles A. Popkin, MD is a team physician for USA Hockey and is a member of the Safety and Protective Equipment Committee. He is an Associate Professor of Orthopedic Surgery at the Center for Shoulder, Elbow and Sports Medicine at Columbia University in New York City. g By Charles A. Popkin, MD Hi, Colin. You have likely heard about several high-profile NHL players who recently sustained Medial Collateral L i g a m e n t i n j u r i e s, i n c l u d i n g Ja c k Hughes of the New Jersey Devils. The MCL is the most frequently injured knee ligament in hockey. The MCL attaches from the femur (thigh bone) down to the tibia ( leg bone) on the inside part of the knee. The most common cause of injury is a collision during which an outside force on the knee pushes the knee inward. This causes stretching and/or tearing of the MCL. The ligament can also be injured by a twisting force to the knee, such as by catching a skate edge. MCL injuries, like other ligament injuries, are graded by severity. Grade I injuries are classified as sprains, which means that the ligament is damaged, but not torn. Grade II injuries are partial tears of the ligament, and Grade III injuries are complete tears of the ligament. Typically, injuries to the upper part of the MCL (femoral side) are more painful than those to the lower part of the MCL (tibial side). However, tibial-sided tears sometimes take longer to heal and need to be monitored more closely. It is important to have any MCL injury evaluated by a sports medicine physician to ensure you have not injured any other structures within the knee joint. Manag ement of MCL injuries initially involves treatment of pain and swelling via the "RICE" protocol— rest, ice, compression wrap and elevation of the injured k n e e . W h i l e f u l l w e i g h t b e a r i n g i s p e r m i tt e d , w e recommend the use of crutches until pain has improved to the point that you are able to walk without a limp. We recommend a hinged knee brace during this period of healing to provide stability to the knee joint. The added stability provided by the brace can help players with MCL injuries walk without a limp sooner than if they did not wear a brace. Dr. Hockey, I got hurt in a game last week when I got checked on the outside of my right knee. My team trainer diagnosed me with a MCL tear. How long am I going to be out, and what can I do to get back on the ice ASAP? – Colin C. Brewster, N.Y. Q A If you have questions for Dr. Hockey, please email Justin.Felisko@ usahockey.org ? T H E D O C I S I N A N D R E A D Y T O A N S W E R Y O U R H O C K E Y M E D I C A L Q U E S T I O N S "IT IS IMPORTANT TO HAVE ANY MCL INJURY EVALUATED BY A SPORTS MEDICINE PHYSICIAN TO ENSURE YOU HAVE NOT INJURED ANY OTHER STRUCTURES WITHIN THE KNEE JOINT." PHOTO BY Michael Carmo Jr; USA Hockey Archive