Last Updated on Sunday, 27 May 2012 18:31
By Dr. Rob LaPrade
Question: I was checked and landed hard on the ice with my knee bent. My knee swelled up and I was told that I have a tear of my posterior cruciate ligament (PCL). What can I do to return back to playing hockey?
Answer: The mechanism you describe is a classic way that hockey players tear their posterior cruciate ligament. The PCL is the strongest ligament in the knee. It’s main purpose is to prevent the shin bone (tibia) from sliding backwards on the thigh bone (femur).
It is very important to make sure that you do not have any other major injuries to the ligaments around your knee. Because the PCL is the largest ligament around the knee, we often found that there are other ligaments injured with the PCL. When these other ligaments are injured in combination with a PCL injury, it is often recommended that you have either a surgical repair or reconstruction of these ligaments within the first 2-3 weeks after an injury to increase the chance that your knee will be functional after it heals.
We recommend that all athletes with a diagnosis of a PCL tear be evaluated by a sports medicine physician and obtain stress X-rays to verify they have a correct diagnosis of their injury.
In your case, with an isolated tear of your PCL, we would recommend an intensive program of rehabilitation once the swelling and pain in your knee diminish. First, you should strive to achieve full motion in your injured knee. Concurrent with this would be to use a special PCL brace to try to hold you shinbone (tibia) forward to prevent it from slipping back on the femur due o the effects of gravity.
The next step would then be to work aggressively on strengthening your quadriceps muscles. The basic exercises that we follow for this are an exercise bike, leg presses, squats and straight leg raises. You should avoid knee extension exercises with weights, because they could cause significant knee irritation.
Each of these exercises may need to be modified somewhat due to the fact that you have an injury to your PCL. The height of the seat on the exercise bike should be placed such that your lower leg is slightly flexed while sitting on the bike. When doing the leg press and squats, you should strive for only partial knee flexion (to about 70°) because full knee flexion puts extra stress on the healing PCL.
It should be noted that we are working to strengthen the quadriceps muscles. This is because the quadriceps muscles pull through the knee cap on the front part of the shin bone which protects your PCL. In general, hamstring exercises should be avoided during the early healing process, because they put extra stress on the PCL.
Once you have rehabilitated your quadriceps muscles back into shape, there is an excellent chance that you could return to full activities in hockey. It is important to have full motion and strength of your knee prior to returning back to sports. I would anticipate that you could be able to return back to full activities in 4-6 weeks.
If you continue to have problems, especially going down stairs or hills, an evaluation and PCL stress X-ray may be necessary to determine if you need surgery. Most PCL reconstructions are performed with two graft bundles and, if performed by a specialist in this technique, usually result in excellent outcomes.
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 toeditor@letsplayhockey.com.
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