Last Updated on Wednesday, 09 December 2015 16:22
By Dr. Rob LaPrade
http://drrobertlaprademd.com
Question: I was checked and landed hard on the ice with my knee bent, which caused knee pain and swelling. I was told that I have a tear of my posterior cruciate ligament. What can I do to return to playing hockey?
Answer: The injury that you describe is a classic way that hockey players tear their posterior cruciate ligament. The posterior cruciate ligament (PCL) is the strongest ligament in the knee. Its main purpose is to stabilize the knee joint by allowing the knee to flex, but restraining both the hyperextension of the knee and the backwards sliding of the tibia (shin bone) relative to the femur (thigh bone).
In your case, the hard fall on your bent knee caused the tibia to slide backwards on the femur with so much force that it overstressed the PCL. Another common way for athletes to tear the PCL is when the knee is suddenly forced into hyperextension.
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 of the knee and it requires such a large force to become injured, more than 90 percent of the time another knee ligament will also be injured. When this occurs, it makes the knee even less stable, so it is generally recommended that you have either a surgical repair or reconstruction of the ligaments within the first 2-3 weeks after injury to increase the chance of a more functional knee 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 the correct diagnosis of their injury.
In your case, if you have an isolated tear of your PCL, we would recommend an intensive rehabilitation program once the swelling and pain in your knee diminish. During this time, a special PCL brace called a PCL jack brace should be worn to help prevent your tibia from slipping backwards.
First, you should strive to achieve full motion in your injured knee. 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 this exercise 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 when the pedal is at its lowest position your 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 degrees) because full knee flexion puts extra stress on the healing PCL.
Your quadriceps muscles pull on the front part of the tibia through the patellar tendon, helping to keep the tibia from sliding backwards. Strengthening your quadriceps, therefore, helps to protect your PCL. In general, hamstring exercises should be avoided during the early healing process because they pull backwards on the tibia and place extra stress on the PCL.
Once you have gone through a quadriceps strengthening program, there is an excellent chance that you could return to full ice hockey activities. It is important to have full range of motion and strength of your knee prior to returning to sports. I would anticipate that you could be able to return to full on-ice activities in 4-6 weeks.
If you continue to have problems, especially going down stairs or down hills, an evaluation and PCL stress X-rays 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.
