It appears that you have partially torn your medial collateral ligament (MCL). Luckily, the vast majority of people who injure their MCL have a complete recovery once they have been properly rehabilitated.

The MCL is actually a complex of ligaments, hamstring muscle attachments, and a thickening of the lining of the joint on the inside part of the knee. The MCL is one of the strongest ligaments in the body. It protects the knee from opening towards the outside. It is most commonly injured when an athlete sustains a direct contact injury to the outside of their knee (such as a clipping injury in hockey or football). Injuries to the MCL are graded I, II, and III. Grade I injuries are mild sprains, Grade II are partial tears of the MCL, and Grade III are complete tears. While the majority of athletes who sustain MCL injuries do not require surgery, occasionally we see athletes with a Grade III MCL tear who have torn their anterior cruciate ligament (ACL) or medial meniscus. It is important to make sure that you have not injured either of these structures, as you may need treatment for them prior to returning back to hockey.

Our treatment protocol for these injuries at the University of Minnesota Sports Medicine Institute has been developed based upon basic research and the results that we have seen in our athletes. As with any initial injury, the initial treatment consists of RICE (Rest, Ice, Compression, and Elevation). It is essential to get the swelling in your knee joint down as soon as possible, as this allows a quicker return to activity. Ice (applied approximately 20 minutes out of each hour) is important within the first 48 hours of injury as it makes the diameter of the blood vessels shrink so there is less swelling in the injured area. In addition, we occasionally use a hinged knee brace in these injuries to provide some stability to the healing ligament in the early phases of rehabilitation.

Once the initial phase of treatment is completed, further treatment would be started with the aim of getting you back to participation as soon as possible. Quadriceps sets are started immediately. This exercise involves tightening the quadriceps muscle, similar to how it would be tightened if you were going to perform a straight leg raise, and holding this tightening for 6 to 8 seconds and then relaxing. Straight leg raises are also initiated immediately. It is important for you to start these exercises as soon as possible to prevent atrophy of the quadriceps muscle which would result in a lengthier period of downtime and could result in more swelling in your knee.

Once you can bend your knee enough, the use of an exercise bike is initiated. It has been demonstrated that early, repetitive cycling motion helps the MCL to heal. We get our athletes on a bike as soon as they can tolerate it and increase the time on the bike based on the amount of swelling in the knee. Once the athlete can get up to 20 minutes at a time with no resistance, the amount of resistance on the bike is increased and they are brought back down to 5 minutes. This protocol is involved in repetition with the amount of resistance increased over time based upon the symptoms that develop in the knee.

The athletes are followed closely and monitored for their advancement in the protocol. They are allowed to return back to participation once they have regained full strength, have no swelling in the knee, and have evidence of healing of their MCL tear (based on no evidence of instability on physical exam). The general time frame that is involved is 1 2 weeks for Grade I tears, 3 4 weeks for Grade II tears, and 4 6 weeks for Grade III tears. A complete protocol can be reviewed on our web site at www.sportsdoc.umn.edu.

In your case, I would first recommend that you make sure that all of your swelling and pain are under control. I would then get on an exercise bike and work hard to regain your overall strength. If you have any trouble at any stage of your rehabilitation, you should check back with your team trainer or physician for reassessment to make sure that there are no other associated injuries present.