Knee Microfracture and Squats

Okay, I’m frustrated. This summer I tore a small piece of articular cartilage off of the lateral condyle of my left femur while playing soccer (it actually felt initially like I had torn my meniscus). The resulting defect was quite small and the surgeon repaired it via microfracture, so I spent six weeks no-weight-bearing and watching my left leg atrophy.

So, now I’m rehabbing and being told by physical therapists not to plan on squatting past parallel in the future. Bullshit. Before the injury, I was deadlifting and squatting at respectable levels for a guy my age – 460 and 355, respectively, for sets of five. Anyway, when the PT’s gave me the “bad news,” I did some questioning of them and got the responses you’d expect, things like: “Squatting’s not good for you if your knees are healthy, let alone surgically repaired.” The surgeon’s opinion was that I should be able to return to whatever I had been doing before, presuming that I cooperate during the recovery process.

All that being said, I’m pretty careful with form and tend to keep reasonably vertical shins during both the squat and the dl. I’ve no history of any significant knee injury or of any unusual pain during either exercise (other than IT band tightness in the squat).

So, does anyone have any experience with this? Or could you point me toward someone who is unbiased against squatting who might be in a position to tell me whether it is reasonable to expect to return to what I was doing before?

Thanks in advance for any help.

Once all is healed and you have progress through a full rehab, you should be able to squat through a full range of motion. Make sure you have proper mobility at your hips and ankles, good tissue quality to surrounding musculature, and good stability at your knees/glute activation. Unless you have a significant deformity within your joint and on your articular surface, you shouldn’t have any limitations to your squat depth provided you have the proper mobility and good movement quality.

Unfortunately, original articular cartilage cannot be regrown.
The tissue that grows into the defect is ideally fibrous cartilage, with inferior biomechanical properties.

It will wear down much much faster then articular cartilage, so I expect that you will start to feel pain again in about 2 to 3 years.
Microfracture treatment is a very good treatment for the short run, and not so good for the long run.

I second what LevelHeaded has to say

Thanks to both of you for your replies.

Two questions for each of you if you don’t mind. First, if the surgery is successful and no complications arise (and rehab is complete), do I run the risk of accelerating the eventual deterioration of the repair by squatting or deadlifting? The way I think about it is if the motion is controlled and correct, I shouldn’t be grinding against the end of the femur except in very heavy workouts (e.g., 3 rep maxes).

I would think that activities that involve explosive lateral movements, jumping, and other sudden compressive forces would be more of a threat to the integrity of the repair, but this is all outside of any expertise that I have so I’m looking for input.

I want to preface my other question by assuring you that I’m asking it respectfully. I appreciate your input but I don’t know your backgrounds (not that there are any keyboard experts on Tnation). On the basis of what expertise/training do you offer your opinions? I’m asking only because I want to be cautious, not out of disrespect.

Last thing: Any reading you might recommend? Do you know of any studies on the question?

  1. I’m not going to pretend that I know that, unfortunatly

  2. I am a 3rd year medical student at the Erasmus Medical University in Rotterdam, Holland.
    I want to become an orthopedic surgeon, and I am now in a program to be able to start the specialisation right after I got my degree.
    I have had quite some lessons about cartilage/bones/ligaments and their structure,… so pretty basic stuff.
    I have made a small presentation about microfractures and have had 2 lessons about it by 2 separate orthopedic surgeons and have witnessed one operation. So I trust that the information given to me is new and correct.

this is a very good site, but a little overwhelming
a lot of links to articles, which are probably not free, but the conclusions you can read

If you have further questions I am willing to ask them to my teachers

  1. With any activity you will run the risk of further deterioration of the knee. Sitting down to go on the toilet multiple times a day could result in deterioration faster. I know, I know, silly/stupid example, but that’s just my personality. It all comes down to risk vs reward. Higher weights will place higher stress on your joints, but I don’t think that it will necessarily be the higher weights that will drastically accelerate deterioration of the knee. It will be more technique based IMO. You may have to alter specific exercises that you used to do; examples include reverse lunges instead of forward lunges, keeping a more vertical shin during squatting movements, limiting high impact activities that will stress the joints higher (box jumps, depth jumps, etc). I look at the situation this way, even if you use lighter weights you will still have higher reps, and if you continue to use a technique that places higher stress on the joint, you will be still be placing a high stress level on that joint.

What are your goals? If your goal is to look and feel better and be able to play a pickup flag football or basketball game, then you need to determine how much load your knees can take in a given time frame and adjust training accordingly. It will be a lifestyle change as well - proper diet to help with inflammation control, healthy lubricated joints, etc. I will not try to say that I know more than just some basics in that field, so people like Johnny Bowden, Brian St Pierre, Berardi, etc would be the resources to look into.

  1. My current credentials are MS, ATC, LAT, PES, CES. What does that all mean? I have my masters in science, did my under grad in Health Science - Athletic Training, am a certified athletic trainer (not personal trainer), am licensed in the state of florida for athletic training, and continued my education to get my Performance Enhancement Certification and Corrective Exercise Specialist certs from the NASM. I honestly don’t feel that means shit, and my experience provided me with a lot of knowledge. I did my undergrad and graduate school at BCS schools and and worked with many collegiate teams, the bulk of my experience coming from football, swim/dive, and baseball. Then went onto work as an Assistant Athletic Trainer at a 1AA school where I was mainly working with Football and also covered baseball, cheerleading, and golf. I currently shifted gears and work in the high level Performing Arts.

  2. Resources I would recommend include Bulletproof Knees.

Hope this helps and best of luck. Again, even with people’s expertise and background, always refer back to the physician you are working with and clear all activities through him/her. We are unable to physically evaluate you and everything suggested is based off of assumptions of your situation.

Sorry it has taken me so long to reply. Thanks much for the input and the resources. It’s heartening to hear from people with more knowledge than I have that maybe I have a shot at doing what I love. Guess I’ve got some work to do.

Thanks again.