(Ed’s note: Our resident health and fitness expert, Cameron Walsh, takes a look at the injury to Evgeni Malkin’s knee along with the path to recovery that the Penguins’ superstar will likely have to travel. – B Metz)
By Cameron Walsh
Well that was interesting news to wake up to, time zones are wonderful things. I figured there would be news about the knee injury to Malkin by the time I awoke this morning, but I didn’t think it would be both his anterior cruciate ligament (ACL) and medial collateral ligament (MCL).
I got to see the collision live for a change, but seeing as the feed I was watching it on wasn’t particularly great and I wasn’t really paying a great deal of attention to the game (I was at work and getting ready to train a client after all), I honestly thought Malkin had tweaked the knee, until I watched him try to get up.
Just like Metz, that was when I had the most concern, before writing this article I had to find a video clip that showed the incident again so I could see the point of contact where Meyers fell into Malkin’s knee. The fall of Meyers was like a slew foot across Malkin (the fall not the play), the skate kind of got caught in the ice sideways, and Meyers’ fell right across his lower leg. With Malkin up against the boards there was nowhere for him to twist to change the angle for his knee to bend (the knee is only supposed to bend one way after all), so it buckled and it is a little sickening to watch over and over to analyze actually. Click here to have a look.
Looking at the diagram you can see the ACL and the MCL location’s (one bonus here is this diagram is actually of the right knee). From reports Malkin has a total tear of the MCL, even without the ACL problems he would not be able to pull a ‘Gonchar’ and play with a brace. If you go back to the piece I did on Jordan Staal there is a little comment about how a partial tear with a brace can still be effectively played on.
Bylsma mentioned in his presser there isn’t much of a chance of Malkin being able to rehab his knee out of this. A torn ACL generally means surgery, there are some new techniques out there at the moment, but we will get to the ACL a little later.
There are as always three grades of tears, Malkin has a Grade III tear of his MCL, he will probably be put into a knee immobilizer and use crutches for the first 7-10 days. Surprisingly straight after the injury he will be taking off the immobilizer periodically throughout each day to work on bending the knee. After that time (7-10 days), Malkin can begin wearing a hinged knee brace, and can begin to increase the range of motion in the right knee. He can apply more weight to the knee as pain allows. Remember guys all of this is in relation to rehabbing a knee with only a MCL injury not both the ACL and MCL injuries he actually has.
Once Malkin can flex the knee at least to 100 degrees, he may begin riding a stationary bicycle. The crutches can be discontinued once he is able to walk without limping. Jogging can begin once he has regained 60% of his quadriceps strength (compared to the opposite side), and agility drills can begin one he has regained 80% of his strength. Complete rehab from a grade III MCL tear can take 3-4 months.
There have been thoughts of Malkin needing surgery for his MCL, seeing as it is almost a certainty that he will have to go under the knife for his ACL, why not go in and surgically repair the MCL too?
Well it does happen but it is pretty rare, many surgeons are reluctant to do this and like to let the MCL heal on its own. However the situation that Malkin is in, where he has injured another major ligament (his ACL) is the exact situation where the surgery on the MCL is undertaken. That being said no significant difference in speed of recovery or improved recovery has been demonstrated in these situations.
Now to the ACL; the ACL doesn’t always need to be repaired by surgery however with most sporting ACL injuries it is. It is usually conducted with an arthroscope surgery, have a read here on a quick post I did on Rafalski’s knee earlier in the year.
There are three traditional types of grafts they can use for a tear like the one in Malkin’s ACL, they include using the patellar tendon, hamstring tendon, and believe it or not a cadaver (donor) graft. I could go over all of the pros and cons here but it is easier if you go here.
There is a fourth surgery for the ACL reconstruction that is being used quite a lot down here in Australia for AFL footballers called a LARS surgery. I am kind of hoping the Penguins and Malkin don’t go down this path, it has had mixed success.
The LARS procedure can get an athlete back up and going quicker than the other 3 procedures, however it has had more cases of failure post procedure than the other three procedures due to the quicker returns. Have a read of this LARS article from a local newspaper down here in relation to the surgery for AFL players.
As you can tell with Malkin taking out two of the 4 major stabilizers in his right knee there are quite a few decisions to be made by the Penguins medical staff, the surgeon and most importantly Malkin himself.
Having to surgically repair an ACL on its own can really affect a player for the rest of his career, now I am not trying to put the fear of god through all of the hockey world, but to have to go and have his ACL put back together and have his MCL either heal over time or surgically repaired, will take its toll both physically and mentally during his recovery.
It will be up to Malkin to rehab his whole body back to 100% not just his quads, hamstrings and his knee, then find the confidence in his body to go back to being the big physical force he was prior to his injuries this season.
I wish him all the best in his recovery.
**Melbourne, Australia’s own Cameron Walsh is a personal trainer by trade, he owns and operates dLuxe Health and Fitness. Walshy is a life long hockey/NHL/Penguins fan and he will be chiming in from time to time on various injuries that pop up in and around this game that we all know and love. He also bears a striking resemblance to the USS Hal Gill… just saying…