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Knee Stability After Knee Surgery

Knee pain

The other day, Bill and I were having a discussion at IFAST about training clients after knee surgery.

If you read a lot of the research out there, it leads us to believe the following:

1 – If you’ve had an ACL tear, even with surgery and rehab, you could be at increased risk for arthritic changes (especially if you’re a female).

2 – If you’ve had a partial meniscectomy, you’re at an increased risk for arthritic changes.  There’s a lot of debate going on about this one, but they’ll generally tell you that 20% is the magic number – more than 20%, wear and tear goes up.  Less than 20% removal, it’s not as big of a deal.

But here are my thoughts on the topic (in case you were interested!) :)

There are two things that people aren’t talking about enough these days.

First and foremost, not enough people are talking about mechanics and alignment.  Secondly, we still don’t have enough people talking about strength.

Let’s look at both, and how improving your mechanics and your strength can help keep your knees healthy for as long as possible.

Improving Knee Mechanics

Many of the people who injure their knees and require surgery come to IFAST post-operatively with obvious alignment issues.  If someone had a partial lateral meniscectomy, would it surprise you to see them with this kind of alignment?


It becomes a chicken or the egg phenomenon – did they injure their knee because of their alignment?  Or did they injure their knee, and then the compensations became apparent later on?

Rather than simply guessing, the only thing we can safely do is address the mechanical issue at hand.

If the pictured client above came to me, the first thing I would do is address their biomechanics, and work to improve their alignment.

Strengthening the hips and reducing their knee valgus would take stress off that lateral compartment, reducing wear and tear.  The hips are crucial to keeping the knees healthy over the long haul.

It’s like a car – if you drive around with the alignment off for months on end, you’re going to unevenly wear down the tires on your car. Your body is no different.

So addressing the mechanics is starting point.  The next step is to strengthen the surrounding structures.

Strength and Knee Stability

When someone has a partial meniscectomy (a minor surgery where they take out pieces of your meniscus), they also reduce passive stability at the knee.

If you look at the picture above, the meniscus does two things:

1 – Acts as a shock absorber/cushion for the knee, helping to dissipate and distribute force, and

2 – Conforms to the femur to increase total knee stability.

Imagine taking out the entire meniscus – how would the femur and tibia would fit together?  What do you think happens when we take away that stability?

It would be a loose, sloppy fit.

So worse case scenario, how can we get some of that stability back?  How can we improve stability in the absence of passive stability that our meniscus gives us?

You’ve got it folks – you strengthen your active stabilizers, such as your quads, calves, and hamstrings (or just about anything else that crosses over the knee!).

Strength training increases stability and helps to compress the joint.  Without that stability, you have a loose, sloppy joint, that’s really going to be subject to increased wear and tear.

(Side Note: Keep in mind that this is a slippery slope.  Obviously, compression can be a good thing with regards to stability.  But, ridiculously heavy training can [most likely] further accelerate wear-and-tear due to the loads involved.)

At the end of the day, we may not have control over what has happened from a surgical perspective in the past.  BUT, we do have control over what we do from this day forward.  Addressing our biomechanics and strengthening our knees are two fantastic ways to keep us healthy and feeling good for years to come.

Stay strong

MR

PS – I would be remiss if I didn’t at least mention my Bulletproof Knees manual here; I cover alignment, biomechanics, and strength training in there, and at $99 it’s about 1/3rd of what you’d pay for a customized program.  The feedback I’ve gotten has been fantastic, so if you’re suffering from knee issues you owe it to yourself to pick up a copy.

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  • Jack Edwards

    Mike,
    For this question, assume (sorry for the major assumption) that steps are being taken to maintain or restore optimal alignment…………………While keeping a more vertical tibia on many movements and opting for ways to reduce loading while still getting a significant training would be wise steps, what's your general take on unloaded (and possibly lightly loaded) movements involving the deep squat/overhead squat, or even something like long-stride lunges where the tibia is anything but vertical at the mid-point of the movement.
    Would those types of ROM's be things that should be attempted to be worked toward/restored as much as possible (or at least safely explore how far you can go in restoring such ROM's in those movements) in spite of prior knee injuries (including the ones you highlighted above?
    For example, in the FMS and SFMA crowds, the deep squat is a big player. A lot of coaches will implement something like a box squat to spare the knees if using a "heavy" movement in training to spare the knees more than in something like a high-bar Olympic or Bodybuilding-style squat.So while using something like a loaded long-stride lunge would likely be contraindicated for certain folks, should efforts still be made to progress back up to such movements in a movement prep capacity (or again, at least explore if this is an option). Or would certain cases simple preclude doing so on account of even bodyweight stresses providing too much stress on certain passive structures?
    Part of me says to just use proper mechanics and the presence or absence of pain as my main guides in such instances, but I realize that this may be me oversimplifying things too much in cases where passive structures have been compromised (and repaired or removed) and can no longer contribute as effectively in a mechanical stability or shock absorption/wear and tear reduction capacity.

  • Maggie

    Hello,
    This doesn't exactly pertain to things addressed above, but I have a question about my knee surgery and I thought it wouldn't hurt to ask you.
    I am 21 years old, and I tore my ACL in july of 2009. I postponed surgery due to school until dec 2009. After 5 months of physical therapy, I couldn't extend my leg all the way, and I was having extremely bad, sharp pain on the front medial side of my knee when I did try to extend it. My doctor was thinking that the pain was either being caused by an impingement or by scar tissue, and decided to do another surgery on my knee, a little less than 6 months after my first surgery. After this surgery, I was able to extend my leg farther than before and the pain was very minimal. The doc said that there was a slight impingement and also some scar tissue in the way that he removed. I am now almost 2 months post op from my second surgery, and the pain in the front medial side of my knee has recently returned. It takes me a good 30 minutes of sitting down in excruciating pain with a tenz unit on my knee to extend it. I also have a painful clicking and snapping on the lateral side of my knee when I walk. I have been going to physical therapy three days a week since my first surgery. I know that it is hard to say anything from me just telling you this, but I was wondering if you might have any idea of what could be causing these problems. It has been almost one year since I tore my acl and I am starting to feel hopeless about ever being able to walk normal or much less run again. Any advice you might have would be greatly appreciated. Thanks.

  • http://Www.tomhamiltonpt.co.uk Tom

    Hello mike,
    Just wanted to say the info you give on knee pain etc is great stuff and has really helped me as a trainer and with my own knee problems after 2 acl repairs and meniscus repairs, I have started to implement your advice into my training. Looking forward to purchasing you seminar DVD. Love you work mate thanks very much

    • Mike

      Thanks for the kind words Tom! Hope you enjoy the DVD’s!