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It usually happens in high mileage engines that have excessive wear to the main bearings (which causes the knock) and too much wear to the oil rings on the pistons (which causes the smoke). A slight knock can mean that you need to add a higher octane gasoline, however, when both knocking and smoking occur, it probably means that you'll have to have the engine overhauled.

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Q: Why does your truck knock and smoke?
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