The Hierarchy of Knee Injuries

Maybe it's me just being cranky, but the public needs to be educated about knee injuries. I am fast becoming an expert in knee injuries since I had knee reconstruction surgery on April 18th, 2012. Make no mistake about it, I am incredibly grateful for this injury because it is forcing and allowing me to grow in areas that I never would have thought possible and because I am learning things that I will forever be able to help athletes with.

Since this has happened, it seems that everyone and their mother has done this too or knows someone that this happened to. Devon and I are finding it quite comical, considering this is a very rare-injury, only happening in the NBA a handful of times and about 25 times in the NFL in the past 30 years. The knee geek forum that I am a member of only has less than 100 victims of this injury world wide. To be clear, I had a complete rupture of the left patellar tendon, which tore both vertically and horizontally, blew out my knee capsule and for good measure, dislocated my knee cap, which was sitting on the inside of my leg at the moment of injury and then was floating in my quad region in the days leading up the surgery.

Nfl 2012

I have heard things like:
"Oh, I almost did that once"
"Now you know how I feel (with a torn ACL)"
"I've been there, you'll be back stronger"
"I did that too"..."O ya? How as the comeback from surgery?"..."Oh, I didn't have to have surgery."

You get the point. I had no extensor mechanism in my leg. My knee no longer existed until I had the surgery. When Dr. Gecha came out to speak with Devon and my father in law, Big Dave, after the surgery, they said he was even shocked at the damage in my knee and rattled off ligament and structure after ligament that was destroyed. No pro-athlete in the major sports has ever successfully come back from this. Guys in powerlifting have thanks to Louie Simmon's and his knowledge and that is why I made sure to reach out to him immediately. To make matters worse, our quads are innervated by L3-L5 of the spine, two of which mine are severely herniated from years of bodybuilding. Will definitely be a challenge, but one that I will educate from.

My PT friend called after the injury and was distraught, saying he sees 15-20 ACL's per year and if he's lucky he will see this injury once every 2 years.

If the following list offends you, it is not meant to. It is merely the reality of things. I have trained many athletes with knee injuries. Hopefully you can learn from this list.  This are only conditions, albeit not every single condition, that require surgery (or not as you will see).  The list goes from most mild to most severe.  I will make it as humorous as possible...

1. Meniscus-  The menisci are very important and provide cushioning in the knee joint.  It is a piece of cartilage without a very good blood supply and thus requires surgery when the time is right.  The provide a an ideal environment for a healthy knee and keeping arthritic knees at bay.  However, I have had friends that have had the surgery and one lifted that same week, one played in a basketball game the week after.  You can live with this injury for months, some people even opt to never get it fixed.  It is the least major of the well-known knee injuries.


2. Dislocated patellar or knee cap-  This is often a scary sight, but not very dangerous.  The knee cap is not being held in groove that is designed for it and will pop out from time to time.  It can be popped back in and you can even walk immediately after it happens, although you will be sore.  If it keeps, happening, you may require surgery to help fix it.  This is level 2.


3. ACL-  For some reason, people seem to think this is the most severe injury in the knee.  I think that has to do with how common it is.  My mother in law doesn't have an ACL in one of her knees and she is fine.  Dejuan Blair of the San Antonio Spurs doesn't have an ACL in one of his knees, Hines Ward of the Steelers, same thing.  Sean Elliott, John Elway and Thurman Thomas all played half their careers without an ACL in one leg.  People that have this surgery are required to start PT one to two days after surgery. I was recently talking with a friend that tore his not too long ago and he said, "I heard a snap.  Not too much pain.  Walked out of the gym and went to the doctors the next day."  Think about that people.  The ACL is a little bigger than the last link on your index finger.  Adrien Peterson is reportedly now finishing first in sprints at optional team practices 3 months after having torn his ACL and MCL.


4. MCL, PCL- This is really 3B.  I am not saying both at the same time.  I am saying one of the other.  PCL is a thicker ligament than the ACL and the MCL will inhibit your movement laterally and agility wise.  This don't happen as often as the ACL.  Also, if your PCL is torn, you will really have to build back up the hamstrings, popliteal and gasrtocnemius muscles which make up the posterior of the knee capsule integrity.


5. Ruptured Quad Tendon- This is much more common than the patellar tendon rupture and happens typically in people over the age of 40.  If you look at a diagram of the knee, you will see there is not much else to get damaged when this happens as most of the knee joint and structure is below the patella.  Tendons do take a long time to heal because of low blood flow.  This has never to my knowledge ended a pro athletes career.  Can be scary though if the quad rolls up on ya.


6. I will put the final 5 together, since they are all rather rare and have significant complications.  Although I will note that the medical website I found this on did say the patellar tendon rupture is the scariest looking of the bunch.

• Knee joint dislocation - A dislocation of the knee joint is a very serious injury and not the same as a dislocation of the patella (kneecap). In this injury, the femur (thigh bone) and the Tibia (shin bone) and moved apart. The major concern here is nerve and blood vessel damage, as well as fractures and soft tissue damage.


• Unhappy Triad - The unhappy triad (sometimes also called O'Donoghue's triad) is an injury to three of the main supporting structures of the knee; The Anterior Cruciate Ligament, the Medial Collateral Ligament and the Medial Meniscus.


• Posterolateral Corner Injury - The posterolateral corner is the back and outer side of the knee joint. A PLC injury involves damage to several structures, which may include the Biceps femoris tendon, Popliteus muscle, Lateral collateral ligament and several ligaments around the outer knee.


• Tibial Plateau Fracture - This is a fracture to the upper surface of the Tibia (shin bone). It occurs from a high impact accident and is often associated with other injuries such as ACL ruptures. It is even more severe if the fractured part becomes displaced.


• Patella Tendon Rupture - The patella tendon connects the knee cap to the shin bone. This is a scary injury to suffer as the kneecap appears displaced in the lower thigh area and it is not possible to actively straighten the leg. Surgery is needed to repair the tendon.

This was a way for me to have a little fun with my injury. I am not saying that if you have any of the above that you have it easy, but realize it could be worse.  I liked what one guy on the forum had to say that had throughout his career torn his ACL, MCL and patellar tendon when discussing his patellar tendon rupture. "This makes an ACL or MCL look like a freakin' paper cut in comparison."  And no, you didn't do the same thing as me:)

The Hierarchy of Knee Injuries

Kyle Newell is the creator of Newell Strength, located in central New Jersey. He specializes in making athletes bigger, faster and stronger. Kyle's methods are among the most unique in the business. He has worked with college strength programs and has competed in numerous bodybuilding shows. Kyle's men and athletes achieve unbelieveable rates of success and performance on the field. You can find out more about Kyle at http://www.newellstrength.com.