Question: I got checked on the inside of my leg and felt a pop on the outside of my knee. I was told that I have a partial tear of my lateral collateral ligament. How long will this take to heal, and what can I do to get back to playing hockey sooner?
Answer: The type of injury that you have is an injury to the fibular collateral ligament (FCL) on the outside of your knee, also known as the lateral collateral ligament. These types of injuries are much less common than medial collateral ligament (MCL) injuries, because most on-ice contact injuries happen when you are hit on the outside of your knee rather than the inside. The ligaments are usually damaged on the opposite side of where you were hit because your knee buckles away from the impact and stretches or tears the ligaments on the other side.
The FCL is a very important structure to prevent the knee from feeling unstable when putting side-ways stress on your leg. This is especially true in hockey players who put more weight on the inside part of their knees when skating, which causes the outside to have more stress on it. If the FCL is torn, the knee joint can gap open on the outside and make it very difficult for any type of push-off or striding activities on the injured side. This is especially true in hockey players because most are bowlegged.
The biggest concern in FCL injury is that when it is completely torn, it usually does not heal. This is in contrast to the MCL, on the inside of the knee, which almost always heals. If the FCL is only partially torn, it may heal with proper treatment in about 6-8 weeks. Therefore, it is very important to determine if there is a complete tear by using a good clinical exam, MRI scans, and stress x-rays. If there is a complete tear, a surgical reconstruction is recommended and the post-surgery off-ice recovery time is about 4-5 months.
In your case, where there appears to be only a partial tear, it is important to give the ligament some time to heal before putting significant stress on it, or it could heal in an elongated position and you could have ongoing instability problems. We usually recommend that athletes be braced for 2-3 weeks with no significant twisting, turning, or pivoting activities to minimize ligament stretching while it heals. To maintain your endurance prior to going back to any on-ice activities, you may bike with increasing resistance for the first 2-3 weeks while wearing a hinged brace – this inline activity will place little sideways stress on the knee that could stretch the ligament.
For high level athletes with a partial tear, we usually recommend the use of a custom made medial compartment unloader brace. Even though it is called a “medial” brace because it is used to relieve compression on the inside of the knee, it is also effective for FCL injuries because it relieves stretching on the outside of the knee. Using this type of brace for the first 6-8 weeks after partial tears protects the FCL injury from going on to a complete tear. While it is possible that a well-fitted hinged knee brace may be effective, we believe that the use of the medial unloader brace significantly minimizes the risk of re-injury.
About 1-2 weeks after the injury, we usually recommend that you can return to on-ice activities with the use of the medial unloader brace. For athletes that choose to return to on-ice activities prior to this time, the medial unloader brace is essential to minimize your chance of re-injury. We recommend that athletes use this brace for a minimum of three months, or until the end of the current season, to reduce their chance of re-injury or a complete tear.
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 firstname.lastname@example.org.