Ok Killer, back from the OS, your opinion?

[archive_EmptyWallet]

Well, I just got back from seeing the OS. I had a scope on thursday as you know, and they just shaved out part of my medial meniscus. He said it was not able to be repaired so he just shaved it out. However he said I also had a cleavage tear I believe he called it? He described it as a tear that is kind of going through the meniscus, like slicing bread in half, kinda see what I mean? Anyway, he left it there, saying that all he could do for that was to remove that whole portion of the meniscus, and I'd that the tear would not in his opinion hinder me at all, and I'd be better with that piece left in there. My knee actually feels pretty damn good. I asked him when I could start lifting again and such, and his advise was to never squat again, or if I did, only go down a few inches. This is kind of troubling to me. He said I could do all the leg extensions I wanted though. I know for a fact he's not knowledgable at all about lifting, or he possibly thinks still that squats are bad for your knees, but this was his opinion. He said whatever I did, I need to take it SLOW. Which I totally agree with. He wanted to keep me doing high rep leg exercises forever, or for at least a year, until he said I might be able to go heavy. I'm not used to that at all. Before I got hurt, I was a squat and deadlift until you puke kind of guy, and now I'm kinda bummed about what he said. Whats your advise? I know for a fact I'm going to take it easy for a bit, but I was under the impression you could beat on a meniscus after its been just shaved since there is no healing. I was thinking of getting on the bike for awhile today. When do you think I should get back to doing leg presses, extensions, squats, and all of that?

You ain't got to be in the pen to be in prison, your in prison in your own fucking mind.
Everything is real on this concrete and steel.

[archive_Killer]

Ah crap, I just lost a page. Well, here goes again...

Well, your doc is on the conservative side. Many docs are. Just depends on his/her ideas and exp. After my quad tendon repair, my doc never told me to stop squatting as he knew my knowledge and realized the point of the op was to get back to lifting legs. He also works on many Bay Area ballers, so he is not use to being conservative. Many docs would have tried to scare me away from squats. However, his assistant did preach to me about leg extensions, she thought they were the devil.

Your doc is worried cuz what is the cushion bewteen your femur and tibia? It is your mensicus. Obviously, you do not have as much now. A squat will cause compressive forces on the mensiscus, increasing as you go lower. The leg extensions cause sheer force which won't effect your meniscus and your ACL should be ok with those now. But, your doc might as well tell you never to play basketball or jump around again, as that will cause alot of compression.

Rehab is really based on swelling and ROM.

0 - 10 days
Ace bandage
Rom as tolerated
Quad sets, SLRs (4 planes), cycling as tolerated, when ok add weights to SLR
Go from full weight baring to partial weight baring on crutches quickly, to no crutches

10 days - 3 weeks
Ace as needed (do not be afraid to use longer than needed)
Rom - normal
Start and progress to full ROM on leg ext and leg curls
Bike full, swim when wounds close

??? 3 weeks (when no swelling and full ROM)
progress to close chain ex (leg press and whatver else you want to do) Maybe includes lots of one legged stuff such as lunges, one leg deads, one leg squats, one leg back extensions. Do what ya like!

Of course, ice after the workouts.

Oh, take glucosamine and chondorsin forever. It will help keep your hyline cartlidge healthy (covers bones).

[archive_Killer]

Here are some studies...

Knee biomechanics of the dynamic squat exercise.

Escamilla RF.

Michael W. Krzyzewski Human Performance Laboratory, Division of Orthopaedic Surgery, Duke University Medical Center, Durham, NC 27710, USA. rescamil@duke.edu

PURPOSE: Because a strong and stable knee is paramount to an athlete's or patient's success, an understanding of knee biomechanics while performing the squat is helpful to therapists, trainers, sports medicine physicians, researchers, coaches, and athletes who are interested in closed kinetic chain exercises, knee rehabilitation, and training for sport. The purpose of this review was to examine knee biomechanics during the dynamic squat exercise. METHODS: Tibiofemoral shear and compressive forces, patellofemoral compressive force, knee muscle activity, and knee stability were reviewed and discussed relative to athletic performance, injury potential, and rehabilitation. RESULTS: Low to moderate posterior shear forces, restrained primarily by the posterior cruciate ligament (PCL), were generated throughout the squat for all knee flexion angles. Low anterior shear forces, restrained primarily by the anterior cruciate ligament (ACL), were generated between 0 and 60 degrees knee flexion. Patellofemoral compressive forces and tibiofemoral compressive and shear forces progressively increased as the knees flexed and decreased as the knees extended, reaching peak values near maximum knee flexion. Hence, training the squat in the functional range between 0 and 50 degrees knee flexion may be appropriate for many knee rehabilitation patients, because knee forces were minimum in the functional range. Quadriceps, hamstrings, and gastrocnemius activity generally increased as knee flexion increased, which supports athletes with healthy knees performing the parallel squat (thighs parallel to ground at maximum knee flexion) between 0 and 100 degrees knee flexion. Furthermore, it was demonstrated that the parallel squat was not injurious to the healthy knee. CONCLUSIONS: The squat was shown to be an effective exercise to employ during cruciate ligament or patellofemoral rehabilitation. For athletes with healthy knees, performing the parallel squat is recommended over the deep squat, because injury potential to the menisci and cruciate and collateral ligaments may increase with the deep squat. The squat does not compromise knee stability, and can enhance stability if performed correctly. Finally, the squat can be effective in developing hip, knee, and ankle musculature, because moderate to high quadriceps, hamstrings, and gastrocnemius activity were produced during the squat.

Med Sci Sports Exerc. 1998 Apr;30(4):556-69. Related Articles, Links


Biomechanics of the knee during closed kinetic chain and open kinetic chain exercises.

Escamilla RF, Fleisig GS, Zheng N, Barrentine SW, Wilk KE, Andrews JR.

American Sports Medicine Institute, Birmingham, AL 35205, USA.

PURPOSE: Although closed (CKCE) and open (OKCE) kinetic chain exercises are used in athletic training and clinical environments, few studies have compared knee joint biomechanics while these exercises are performed dynamically. The purpose of this study was to quantify knee forces and muscle activity in CKCE (squat and leg press) and OKCE (knee extension). METHODS: Ten male subjects performed three repetitions of each exercise at their 12-repetition maximum. Kinematic, kinetic, and electromyographic data were calculated using video cameras (60 Hz), force transducers (960 Hz), and EMG (960 Hz). Mathematical muscle modeling and optimization techniques were employed to estimate internal muscle forces. RESULTS: Overall, the squat generated approximately twice as much hamstring activity as the leg press and knee extensions. Quadriceps muscle activity was greatest in CKCE when the knee was near full flexion and in OKCE when the knee was near full extension. OKCE produced more rectus femoris activity while CKCE produced more vasti muscle activity. Tibiofemoral compressive force was greatest in CKCE near full flexion and in OKCE near full extension. Peak tension in the posterior cruciate ligament was approximately twice as great in CKCE, and increased with knee flexion. Tension in the anterior cruciate ligament was present only in OKCE, and occurred near full extension. Patellofemoral compressive force was greatest in CKCE near full flexion and in the mid-range of the knee extending phase in OKCE. CONCLUSION: An understanding of these results can help in choosing appropriate exercises for rehabilitation and training

Sports Med. 1997 Jan;23(1):61-8. Related Articles, Links


Partial meniscectomy and osteoarthritis. Implications for treatment of athletes.

Rangger C, Kathrein A, Klestil T, Glotzer W.

University Hospital of Innsbruck, Department of Traumatology, Austria.

The biphasic ultrastructure of the meniscus and of articular cartilage provides their function in the complex biomechanics of the knee joint including load distribution, shock absorption, viscoelasticity, a smooth low friction gliding surface and resilience to compression. Meniscectomy may lead to destruction of cartilage and to osteoarthritis of the knee joint. Osteoarthritic changes after meniscectomy have been reported in up to 89% of patients. Retrospective analysis after open or arthroscopically assisted meniscectomy revealed restriction in sports to be between 2 and 50% and cessation of sports to be between 2 and 25%. Generally, patients with degenerative changes at the time of surgery are reported to have lower knee joint function and to resume sports activities later. Pharmalogical measures to treat osteoarthritis following previous meniscectomy include pain medication and intra-articular drug administration. Additionally, range of motion and strengthening exercises and moderate athletic activities are recommended. When surgery is considered, correctional osteomies and unicompartmental or total knee arthroplasty depending on the degree of osteoarthritis are preferred.

[archive_EmptyWallet]

It's been 5 days since the scope, and I'm doing pretty freaking good right now. My knee actually feels good and my range of motion is pretty decent. Swelling and popping/cracking noted, so I think I'm going to be cycling, and doing standing squats with just my bodyweight maybe? I really don't need the quad sets are anything. I can actually fire my quad better now than before surgery. MY quad seriously feels stronger. No kidding. I did all the stuff you listed after my ACL, however after like the first day out of surgery, my leg feels pretty good considering its cold. I think I'm going to just keep and eye on it and pace myself. Here's my plan.

Cycling everyday just about 15-20 min or so.
Twice a week, or maybe three times, doing standing squats with just my bodyweight. (Or should I wait a bit on those?)

After a few weeks, I would progress to all the one legged exercises with weights.

You ain't got to be in the pen to be in prison, your in prison in your own fucking mind.
Everything is real on this concrete and steel.

[archive_EmptyWallet]

One more thing. What do you make of that cleavage tear that he said he didnt mess with? The kind of horizontal sandwhich like tear I have?

You ain't got to be in the pen to be in prison, your in prison in your own fucking mind.
Everything is real on this concrete and steel.

[archive_Killer]

Your plan sound good. I would add in some leg ext and curls and start with some shallow bodyweight squats and presses. As you are exp in rehab, you know to let your body be the guide and will do well with that.

The cracking is just the result of the swelling, as your patella is probally not gliding quite right yet.

If it is horizontal, there is a good chance that it won't cause any problems, as it won't cause any "catching" or locking. The more mensicus the better!

As we previously talked about, many football players will be scoped and back on the field in 3 or 4 weeks. I believe that is what Maurice Clarett had done in '02.