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Q&A: Partial knee meniscectomy

Bulletproof Knees

I had partial meniscectomy done recently (70% of anterior medial meniscus is gone due to bucket handle tear). Now I’m recovering fine, with no pains, swelling or clicking whatsoever, but I was told to avoid impact activities, and pretty much to stick to biking only.

I don’t like “biking only” idea, since it would probably overdevelop quad relative to posterior chain. So I’d prefer to do deadlifts and bulgarian single leg squats (or reverse lunges) as well, and possibly more.

Do you think these activities 3x week will accelerate the cartilage wear due to meniscus deficiency?

Regards,
G.

P.S. My surgeon was not enthusiastic about any exercise that put knee under load when flexed over 45% degrees. And sticking to that rule results in a very pathetic range of exercises….

G -

First off, thanks for purchasing Bulletproof Knees!  Let’s take a look at your question.

Keep in mind that even with a partial meniscectomy, contact stresses are going to be increased in your knee.  When they take out any portion of your meniscus, you lose some of your body’s shock absorbing capacity.The greater the section removed, the greater the increase in stress.  As well, it’s generally accepted that increases in knee flexion (i.e. more range of motion) further increases these stresses.

However, there’s a lot more to it than simply giving you a cookie-cutter answer.  I would ask you the following:

-       What is your age?

-       What is your current activity level?

-       What are your short and long-term physical/athletic goals?

Without knowing more about you, I can’t tell you “Do this,” or “Do that.”  I’ve known people with really dodgy knees whose only goal was to successfully compete in Olympic of Powerlifting meets, so my advice to them would be different than what it might be to you.

I think what you need to do is figure out what you want to accomplish long-term, and then proceed accordingly.  If you want to strength train for as long as possible, here are a few suggestions:

-       Train with a vertical tibia. This means single-leg work, squatting, deadlifting, etc.  As my good buddy Charlie Weingroff always says, a vertical tibia helps spare the knee.

-       Reduce high impact/high force activities. Unless you want to play high-level sports, I would reduce or eliminate most plyometrics, jumps, etc.  Obviously O-lifts and heavy squats/deads could be placed here, but most people aren’t willing to give these up!

-       Foam roll/static stretch/warm-up how I outline in the knee manual. Improving soft-tissue length and tension around the hip, knee and ankel is very important.  It’s worked for a lot of people, and it should work for you as well.

It’s not a cut-and-dry answer, as you can see, but hopefully this has given you some insight to work from.

Good luck with your training!

Best

MR

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  • Marko

    Mike,
    If the meniscus is knee shock absorber, wouldn't the squats be harmless to it as there is no direct impact like in running and jumping? Not only that but if articular cartilage is not in bad shape shouldn't heavy lifting preserve his knee and make it stronger? I'm 26 and had 20% removed, lifting is only thing that keeps me sane. Christ, I don't want to stop ever.

  • Trent

    Mike,
    Wanted to say thank you for the Podcasts. I listen to at least one a day and have listened to several multiple times and some, like Pavel's back-to-back. A lot of times we offer ourselves to others for free and get nothing back. I get so much from having access to your podcast. Thank you.

  • Bill Paxson

    Mike,
    For those with designs of still competing in sport on some level or continuing on with certain things that may be less-than-favorable with a prior issue like this, would it essentially be a case of accepting the new risk:reward ratio that is now skewed more toward risk, being more conservative with volume and more regular with lower body deloads, and keeping in whatever represents "just enough" for this athlete in order to continue being able to perform at a given level without exposing yourself to too much risk?

  • Rick Kaselj

    Mike,
    Great info.
    There was some research that came out on squatting and knee forces.
    These are the suggestions they made:
    TIBIOFEMORAL JOINT DISORDERS (Meniscus or Osteoarthrtis)
    - Avoid wide stance squats
    - Avoid narrow stance leg press
    - Tibiofemoral joint force increased with deep squat or leg press
    (Escamilla, 2001)
    Rick Kaselj http://www.ExercisesForInjuries.com
    .

  • Mick

    Mike,
    Can you explain what exactly a "vertical tibia" means? Thanks!

  • Finster

    Mick,
    I think "vertical tibia" means doing exercises where your shins remain basically perpendicular to the level surface on which you are standing.
    Examples of exercises that are easy to do in this fashion would be step-ups, lunges, and Bulgarian split squats.
    I have a pretty hinky L knee–had much of the medial meniscus cut away 18 yrs ago @ age 32 after tearing it playing basketball, with arthritic symptoms now setting in–and I perform all those exercises pain-free both with bodyweight only and with reasonable amts of added resistance.
    In short, I've discovered that I can keep training, but have realized that it needs to be more of a "thinking person's game" when chronic joint issues are present. As my bone doc puts it, you want to work the joint without "provoking" it.
    I would also put in a good word for kettlebells. Plain old 2-handed swings–THE basic k'bell exercise–can give you a heck of a workout w/out requiring knee flexion much past 45 degrees.

  • Emmett

    First, I'd like to thank all who give freely of thier expertise. I am a 63 yr old faher of two, who works 12 hr night shifts three times a week and I have had a L knee meniscectomy after a posterior bucket tear and I'm bow legged. I click when I walk at times but at 228 lbs I can still butt to heels 250 lbs and dead 305lbs. What can I do as accessory work to help my knees, if anything?
    Thanks for your help and this forum.
    Emmett Marrone

  • Cameron

    I'm a 20 year old college student who just likes to play sports recreationally. I had a partial knee meniscectomy in my right knee removing 70% of my lateral meniscus when I was 14. Would plyometrics be an extremely bad idea?

  • Karim Mitha

    Hey Mike,

    First off – just want to say the material you have put together on knee pain is phenomenal. My physiotherapist recently informed me of your blog and I look forward to incorporating your techniques into my training.

    A bit of background about myself, I’m 24 year old male, and I tore my ACL about 6 years ago. Since the initial injury my knee has been on a downward spiral. I was finally able to get an ACL reconstruction in 2008, however 6 months post-op I experienced a deep tear in my medial meniscus, and the majority of it has since been removed in a second surgery.

    I now find the knee with chronic pain, I’m unable to play any impact sports, and I haven’t found much correlation between decreased pain and strengthening. The only thing that seems to have helped has been orthotics. Although I continually see the benefits of strengthening the knee and improving the bio-mechanics, I feel that there is only so much rehab can do when a significant structural problem is present.

    I have recently come across The Stone Clinic – one of the leading pioneers of knee reconstruction in the USA. Dr. Stone was invited to speak on TED.com, and they have been very successful at pioneering biological knee reconstructions and meniscal transplantations using allograft and synthetic tissues. Although this surgery has been around since the 90′s in limited capacity, the success rates have typically been quite low (below 50%). This clinic seems to have bridged the gap, and their success rates are above 85% – which is quite impressive when the majority of their patients are elderly with severely arthritic knees.

    Given that you’ve suffered a similar injury and worked with countless patients, I was curious as to what your take is on reconstructions of the meniscus. Would you consider a surgery necessary, or do you think that the right training would allow someone with a deep tear to return to impact activity?

    Would love to get your insight on this,

    Karim

    Here’s some background info if you’d like to have a look:

    http://www.ted.com/talks/kevin_stone_the_bio_future_of_joint_replacement.html
    http://www.stoneclinic.com/data/fe/file/LessonsLearned100MeniscusAllografts.pdf

    • Mike

      Karim –

      I think stem cells are the future of joint surgeries and rehab, but I’m not sure the technology and science is where it needs to be just yet.

      If you’re in a worst case scenario and avoiding a joint replacement, it may be worth checking into. If you’re not in dire straits, I would do your best to rehab it and make the most of what you’re got.

      Hope that helps. Good luck!

      MR

  • aparna dhadwe

    Hi! i had partial meniscectomy of left knee done two months ago. I m doing regular exercise twise in a day after surgery. now i can walk properly but not comfertably use staircase. also i having pain specialy doing exercise i.e lifting my leg at 45 degree from ground level. I use ice wnile paining starts. How much time it will take for complete recovery.?what i want to do to overcome this pain?

  • Krissy

    Hi,
    My name is Krissy and I just had my second knee operation 2 weeks ago.
    In 1999, age 17, I tore my right ACL and damaged my meniscus. I got a tendon graft and nothing (as far as I know) done on the meniscus.
    A few months ago, I decided to increase my training to compete at CrossFit. After all these years of dreading a new injury (there were a few scares in between) I figured I could do it. Wrong. I got a bucket tear in my medial meniscus (same knee) during a kettle bell class. Not so hot on KBs any more… I got arthroscopy 2 weeks ago (I’m almost 30 now) and I don’t know how much cartilage I’ve got left. I do know that they removed the tear and there was some scarring on the posterior horn that they remodelled too. So I’m thinking they probably removed about 60%.
    Now I am really worried. The basis of my training was barefoot running (not actually barefoot but with minimal shoes, which has proven a lot more gentle on my knees than regular running), and a combination of squat jumps, box jumps and full ROM 1 leg squats (with free leg in front). I have not been able to talk to my surgeon yet, but after surgery, I was told I could run. Is that so?
    I can’t imagine not doing any of my old training any more. I’ve always been into doing the hardest possible stuff I can find. Now what? If anything, I want to stay vertical, walking (preferably running) and NOT develop osteoarthritis for as long as humanly possible. But losing the ability to do a hardcore training (along with all the muscles) I cannot imagine.
    What do you recommend? I have never heard of you until today (Google does that). The physio exercises I’ve been given are seriously limited. I used to be a martial artist. Any chance to do that again? Any kind??
    I appreciate your help.
    Krissy

    • Mike

      Krissy –

      I understand where you’re coming from, and hopefully we can get you fixed up. It’s not going to be easy, though.

      Have you ever thought about doing some online coaching? Or depending on where you live, working with someone qualified in person? With no disrespect meant towards CrossFit, you need to find something that is going to get you right first and foremost, and then work to re-build your fitness levels.

      Let me know how I can help. Good luck!

      MR

  • Jeffrey

    Check out Actifit by Orteq and NuSurface implant for medial/lateral defects after meniscectomy. These two look very appealing to slow or eradicate degenerate joint disease and get you back to as good as you can be.
    They are new techniques, and as of this year are beinga practiced a bit more, so this fantastic news for those with knee problems at a young age! Be grateful!
    Only problem is that they are currently expensive, I reckon in a few years it will be a different story (hopefully).
    Also practice Bikram Yoga, its amazing! It really gets rid of the horrible pain in the knees after surgeries of this kind and really creates space in the joint keeping the rest of it as healthy as possible, because remember after a meniscectomy pressure is increased on the articular cartlidge and this is not good! So Bikram really gets rid of pain, you just have to stick with it for atleast 6 months of regular practice and then you will feel the benefits!

    Good luck all.

  • B. P.

    I’m a professional boxer (middleweight) facing a partial meniscectomy for a medial meniscus tear. I think it was brought on/ aggravated by jumping rope. If I get this done what limits if any , will I have in training?

  • Caid f.

    Hey mike. My goals are to stay healthy and fit for the rest of my life. I am 24 and just had a partial meniscectomy today. I’m scared. I just want to be able to sweat day in and day out eat healthy and play with my kids. Will arthritis pain stop me in my tracks fairly soon? I weigh 176 pounds, and am a male. Any information you can give on this will help me out gratly! Thanks
    -Caid