Knee subluxation and squatting

[Zach Passman]

Rip et al-
My wife has for years suffered from subluxation of her right knee. Occasionally this knee will "give out," usually related to instances of stepping on something unstable (ie a rock in a parking lot), or if running around on a less-than-flat surface (chasing our kid outside).
8 or so years ago, she consulted with a orthopod--who recommended a surgical procedure where the lateral tension on the patella is relieved by cutting ("releasing") the ligament. IE the ligament on the lateral side is "too tight," and this procedure just makes it less likely to contribute to the knee's subluxation by loosening that tension. This purportedly allows the patella to remain in the trochlear groove.
Do you have any experience with this particular injury? Does your experience indicate that the balanced strength developed through squatting contributes to a stronger, more stable knee? My own experience suggests that by making her legs, hips, etc stronger will better allow her knee to function and remain more durable. "Sports Medicine" docs would prefer to just perform the surgery, since that's what they like to do. Before Hannah considers a surgical procedure such as indicated above, I'd like her to make a committed attempt at getting her legs stronger to mitigate the issue.
I'd like to get your feedback on whether you would recommend any particular coach/trainer/facility in the Northern Virginia area. I know you have a list of SS-approved seminar attendees, but not all trainers are created equal. I have not-insignificant experience with both training and coaching, but I will not be coaching my wife.

Thanks for any feedback you can provide.

[Mark Rippetoe]

Many thousands of words have been written on this board about this very topic, so I'll let you search instead of me type. In northern VA, look up Gillian Mounsey.

[Zach Passman]

Not so many words as you might think--I pay attention. Thanks for the recommendation.

[Mark Rippetoe]

Yeah, back before you signed up. Lots of words. And now I see that Mac and Gillian are moving to NC. Better hurry.

[stef]

Do you have any experience with this particular injury?

Yes.

Does your experience indicate that the balanced strength developed through squatting contributes to a stronger, more stable knee?

Yes.

My own experience suggests that by making her legs, hips, etc stronger will better allow her knee to function and remain more durable.

Yes, and getting everything strong makes a lot more sense than trying to balance a system by making other things weak. Other stupid advice from "sports medicine" folks such as "do not run or jump again" delivered to 15 year old females is also worthy of being ignored.

[Zach Passman]

Next you'll be telling me that deadlifting's not bad for my back.

The most challenging part of this equation will be getting my wife (or anyone without the inclination) to accept the hard work that squatting has for her. You can lead a wife to water, etc. Thanks for your replies--we'll hustle and get with them.

Regards

[HunterHenzler]

When I was younger I dislocated each knee in the same year (approx 10yrs old) Was told it was due to my hitting a growth spurt and the muscles/tendons/etc. not "catching up".
Later on (soph. year of high school), I dislocated a knee again during football. THis was an unlucky situation where a cleat got stuck in some uneven ground and SOMETHING had to give.

All three times the patella completely slided out of place to the outside of the intended loscation- a full kneecap's width outside. Weirdest looking thing ever.

It turns out probably the biggest contributing factor of my dislocations were weak VMO's (the tear drop shaped muscle on the inside of the legs) compared to the rest of my quads. Had they been up to par strengthwise then I think it's likely none of the dislocations would've ever occurred.
I personally like the idea of overall strengthening- IIRC then strengthening the VMO will be a MUCH better idea to "pull the patella back into place" then to relieve the pull by cutting a ligament.
I personally don't like the idea of cutting a ligament at all.
So my advice would be just overall strengthening of the quads- with some extra "rehab" (maybe as a warm-up & cool down) for the VMO.

Please feel free to add to/correct me if I'm not right.

[cpbellavia]

Next you'll be telling me that deadlifting's not bad for my back.

It's not.

[Mark Rippetoe]

It turns out probably the biggest contributing factor of my dislocations were weak VMO's (the tear drop shaped muscle on the inside of the legs) compared to the rest of my quads. Had they been up to par strengthwise then I think it's likely none of the dislocations would've ever occurred.

Some of my favorite PT mythology. Weak VMO. Not to pick on Hunter, cause he's a good guy, but would someone please explain how one of the three vastus muscles in the quads gets weak while the others stay strong enough? Perhaps I just don't understand how their common insertion and innervation would permit this heinous abrogation of duty.

[Briks42]

I had a full dislocation of my left kneecap at age 15. Then had approximately 12-15 partial dislocations (subluxations?) of the same knee in the next dozen years after that. Since I started squatting though, I haven't had a dislocation. I am also less active than I had been though, which means fewer opportunities for dislocations.

That being said, I was experiencing some sharp pains at the bottom of my squats from loose bone chips around the knee from all the dislocations. However, a scope to remove them solved that problem and that knee has been good to go since then.