Squats and Multiple ACL Tears

Hey T-Nation,

This is my first post on these forums. This post is for people who have gone through or are going through similar experiences as me or have knowledge in this area (like PT’s or Trainers). I have messed up knees. I tore my ACL, MCL, and meniscus in multiple regions in a freak basketball accident about a year and a half ago. I got surgery on my right knee using my hamstring graft from the same leg.

Due to some levels of stupidity from my part, I had another accident and managed to obliterate my same knee only four months into my rehab. And I got pissed off and didn’t opt into surgery until a few months after when I realized life was awful with a bum knee. So I got another surgery done on the same knee this time using my patella tendon from my right knee since my doctor believed that would be the strongest ACL.

Long story short, this horrible phase made me re-evaluate my life and I decided to become strong as f#*& so I started lifting. I have lifted before but only for athletic conditioning so it was a different kind of training. Now I lift for strength and power.

Anyways, I am now 8 months of my second surgery and my knee is feeling pretty stable. The big problem I am having is that during squats, my patella on my bum knee flares up like crazy. I have pretty good form and I go ATG. Also I go for reps and keep the weight low, two plates or less. I just push through the pain. It doesn’t affect my workout because my leg muscles are worked really good. It just annoys the crap out of me because the pain radiates and makes me limp around.

I want to know is this going to stick with me forever or is that pain ever going to subside? What should I do to mitigate it? Stretching? Ice? Hot sauna? Any suggestions would be great.


Hi mate,

I got ACL reconstruction with the hamstring tendon 2 years ago. Now I’m back at playing rugby and stronger than before.
First thing: do you foam roll? Rolling the IT-band really helps with knee pain.
Second: do your kees come inward or your arch in your foot drops while squatting, this can irritate the knee a lot?
Third: epsom salt baths have been helping me a lot with alleviating pain in my knee, so that might be something to try
Fourth: high rep (20) low box single leg squats with slow eccentric and concentric also helps with my knee keeping healthy. I just have a box in my room and doing a lot of those just spread out during the day.

Last: for me, heavy squats with really slow eccentrics works like magic.

Where in your patella is the pain? Deep, superficial, medial side, lateral?

On instinct I want to say that your patella probably has restrictions in its movement. If you were seeing a physio, I would want to call him up and ask about patellar mobilizations. Theyre super easy, you basically just wiggle around your kneecap. A patellar graft for your ACL repair is the gold standard, the issue is you have taken tissue from your patella so you need to keep patellar tendinopathy on your radar. This is one of the few times I would recommend against squatting to 90 degree, that would place maximum pressure on your patellar tendon. Squatting ATG is okay, being mindful of the risk for your menisci, and I believe (not 100%) that leg press doesnt put the same stress on your patellar tendon.

So, my recommendations:

  1. Ask your physio about mobilizing your patella.
  2. Keep squatting, avoid stopping at 90.
  3. Foam roll, IT band and quad in particular.
  4. The exercises rpm500 stated are good ideas, the first is good for proprioception and the second is good for stability (eccentric training focuses on stability)