Knee injuries in hockey goalies: the meniscal tear

Injuries are part of the sport and hockey goalies are not immune. For hockey goalies, the meniscus tear can have an impact on performance and it can also have an impact on their other daily activities. Let’s look at the symptoms of meniscal tears, the mechanisms of the meniscal tear, and what you can do to prevent or recover from this injury.

The knee hinge joint is made up of the femur (thigh bone) and the tibia (shin bone). The end of the femur is somewhat rounded like a knuckle, where the tibial plateau is relatively flat. The knee is not the most stable joint, so the menisci (you have two, one medial and one lateral) help give the joint surfaces a bit more depth and provide a small cushion between the femur and the tibia.

The menisci are shaped like a hockey puck that has been slightly flattened in the middle. It is a cartilaginous material and the big problem with meniscal tears is the fact that the meniscus has a poor blood supply. The outer edge of the meniscus has some blood supply, so a tear in this area can heal. As you move toward the center of the meniscus, there is little or no blood supply, so tears in this area will not heal.

When working as an exercise specialist in a sports medicine clinic, one of the physical therapists had an amazing analogy of what meniscus tears are and how they feel. She described a meniscus tear as a “hanging nail” in the knee. You know how you can have a hanging nail and it usually feels good, with no pain at all, until you catch that little flap of skin going against the grain. When that happens – WOW! Be aware; major pain.

Hockey goalies who have a meniscus tear may be fine to complete all the activity they want, but then they can walk around a corner or fall on your butterfly and ouch! The knee may even give way from the jolt of pain. If you feel general pain under the kneecap, it is likely more of a patellofemoral irritation than a meniscus tear.

The tricky thing about meniscus tears is that there are numerous mechanisms. I remember a person who spent an afternoon on his knees while going over a floor and when he went to stand up, ugh, a meniscal tear. But for hockey goalies I think there are two common mechanisms.

1. There is a collision between a skater and a goalkeeper in which the skater falls on the goalkeeper’s knee when in a flexed position or the goalkeeper is pushed back with his foot trapped under them.
2. The goalkeeper moves to a position where the knee is under medial / lateral stress (varus or valgus) and puts pressure on the meniscus which, over time or in an instant, can cause an irritation or tear of the meniscus. I am thinking particularly of the butterfly position of the goalkeepers.

The goalkeeper will feel pain at the time of injury and there may be some swelling in the knee. If you think the meniscus has torn, start with rest, ice, and elevation. It can settle. If your knee is locked, meaning you cannot physically strengthen it, or if you are trying to do so is causing significant pain, you should go directly to the phone and call your local sports medicine professional.

If your meniscus has torn, you should receive physical therapy from a good sports physical therapist. If it’s a severe tear, you may need to see an orthopedic surgeon who can perform a knee-reach to remove some of the rough edges and “clean” things up a bit. If it is a large tear towards the inside of the meniscus, the surgeon may decide to re-sew it, which helps preserve the meniscus, which over time will greatly reduce wear and tear on the knee over time.

Whether you’ve injured your meniscus in the past or you’re a hockey goalie looking to reduce your risk of injury, the basics are the same. As long as you don’t have symptoms, you want to make sure to include work on internal hip rotation so that you can get into your butterfly by reaching range from the hip, not squeezing through the knee.