Former U.S. midfielder Stuart Holden has undergone knee replacement surgery at age 36.

“It’s been a tough reality to swallow, but ultimately I know this is what’s best for my body and overall quality of life,” Holden wrote on Instagram on Friday, posting a photo of himself wearing hospital clothes and on a gurney. “The last 11 years have been a challenge mentally, physically, and emotionally — but I’ve learned a lot about myself during it all. The lead up to the surgery has brought back memories and emotions that I’ve buried for years.”

Holden said the procedure was partial replacement of his left knee.

“It got to a point where I couldn’t walk without a limp, run or keep up with my 6 year old daughter,” he wrote. “The pain and swelling were unbearable and I needed to do something about it.”

Holden said had six knee operations over 11 years, and he retired from playing at age 30 in 2016 after scoring three goals in 25 international appearances. He played for Major League Soccer's Houston Dynamo from 2006-09 and Bolton from 2010-14, with a loan to Sheffield Wednesday in 2013.

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He has worked since then as an analyst for Fox.

Holden's right leg was broken by Nigel de Jong’s tackle during the Americans’ exhibition game at the Netherlands in March 2010 and his left knee was injured by Manchester United defender Jonny Evans in March 2011.

He returned from surgery to play that September, then needed surgery eight days later to repair cartilage damage. He tore his right anterior cruciate ligament during the 2013 CONCACAF Gold Cup final against Panama. He felt discomfort during an under-21 match for Bolton in March 2014, had another right knee operation and never played again.

“Looking forward to finally (hopefully) being pain free for the next 1,000 years,” Holden wrote. “Should be good for a comeback! Who’s signing me?”

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Stuart Holden

Former US midfielder Stuart Holden has knee replaced at 36