🏥 What happens on ACL surgery day?
Anaesthesia: Surgery may use general or spinal anaesthesia. Sometimes the nerves around the surgical area are temporarily numbed with a nerve block to control pain in the first hours. Your anaesthetist will explain the appropriate option. Before discharge, ask the anaesthetic team how long numbness and weakness from your block are expected to last. If you are home with continuing numbness or weakness and that duration is unclear, contact the hospital or anaesthetic team the same day for advice; do not wait a week. For progressive weakness or numbness, follow the emergency warning-sign instructions.
Recovery and stay: Pain, nausea, alertness, blood circulation and sensation in the foot, and safe crutch use are checked after surgery. Dr Emad’s plan includes an overnight stay; your readiness for discharge is also assessed.
At discharge: you receive a discharge sheet with care instructions, the prescription for your medicines, walking aids (such as crutches) and a knee brace — in Dr Emad’s programme every patient is given a brace. Arrange for someone to take you home.
Pain and swelling: both are expected early, but do not assume that increasing or uncontrolled pain, or sudden or increasing swelling, is normal; in those cases, contact your care team the same day.
⚠️ Warning signs: when should you call urgently?
Same-day contact with your care team: steadily increasing wound redness, warmth or drainage, wound edges opening, thick foul-smelling discharge, a fever of 38.5°C or above, pain not controlled by the prescribed plan, sudden or increasing swelling, substantial calf or thigh pain and swelling even without breathlessness or chest pain, new numbness after sensation in the leg has returned, or numbness or weakness from a nerve block that persists beyond the duration advised by the anaesthetic team, or sudden loss of a movement you could previously perform.
Seek emergency help: shortness of breath, chest pain, a very fast heartbeat, coughing blood, fainting, a cold or blue foot, progressive weakness or numbness, or substantial calf or thigh pain and swelling together with breathlessness or chest pain. In Iran, call emergency medical services on 115.
If your symptom is on neither list above, first look at the section of this guide that covers it. If you are still worried, do not wait until tomorrow: call Dr Jalil Emad’s clinic on 09137825207, or book an appointment online. In an emergency, do not wait for the clinic to reply; follow the instructions in the emergency box above.
1Care during the first days after surgery
During the first few days, the knee is not expected to be completely free of pain or swelling. The aim is to keep both manageable, keep the incision clean and dry, and begin simple movement without adding unnecessary stress. Work through the steps below calmly and consistently; that routine usually makes the early days more predictable.
🩹 Wound care and dressing changes
Seeing the incision or changing the first dressing can feel unsettling, but there is no need to rush. Take a few minutes, set out the supplies first and work through each step calmly; the aim is simply to keep the wound clean and dry without unnecessarily disturbing healing skin.
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- Before you begin, wash your hands with soap and water and prepare the supplies on a clean surface.
- Do not open the dressing before your first clinic visit, 10 to 14 days after surgery; it is changed at that visit, in the clinic. Only if it becomes wet, dirty, loose or soaked with blood or drainage before then, replace it at that moment with a clean, dry dressing and call for an earlier appointment.
- Peel the outer layer slowly from one corner. If an area sticks, do not pull suddenly; sutures, skin adhesive, narrow closure strips and scabs should remain in place. Under Dr Emad’s plan, sutures that need removal are taken out 2 to 3 weeks after surgery.
- Look briefly at the wound and surrounding skin without pressing. Do not touch the incision line, pull the edges apart or leave the dressing off longer than needed.
- Permission to change a dressing is not permission to wash the incision itself. Wash your hands and clean only the surrounding skin without wetting the incision; wash the incision with clean water only when your care team has allowed this for your closure, covering and the wound’s dry, closed condition. Do not apply soap directly to the healing incision, and pat the area dry with a clean towel. Do not put alcohol, hydrogen peroxide, povidone-iodine, ointment or a new solution on the incision line; these irritate healing skin and slow it down.
- Finish with a clean, dry dressing that is not tight. The tape should hold it in place without pulling the skin or causing numbness or a colour change.
- A small clear or pale-pink stain can appear during the first few days, but it should lessen from day to day. If the drainage does not lessen from day to day or increases, or if you see increasing redness or warmth, wound-edge separation, or thick foul-smelling drainage, read the warning-sign section and follow what it says.
🚿 Waterproof dressings and showering
The key when showering is to stop water getting underneath the dressing and avoid rubbing healing skin.
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- From 48 hours after surgery you may take a short shower, provided the wound is dry and the waterproof dressing is intact.
- Do not aim a forceful stream directly at the knee or scrub the incision with soap or a washcloth. Afterwards, pat around the dressing dry with a towel.
- The waterproof cover goes over your own dressing and does not replace it; after each shower take off only the cover and leave the dressing underneath alone. Replace it straight away if an edge lifts, water gets underneath or it becomes dirty.
💊 Your medicines and how to take them
Not every patient is prescribed all of these medicines. Read the amount and duration from your own prescription, and if you are unsure, ask your doctor or pharmacist.
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- Cephalexin: This antibiotic prevents infection at the surgical site and is taken for 7 days. If hives, swelling of the face or shortness of breath appear, stop the medicine and call emergency services right away.
- Aspirin or apixaban: To prevent blood clots in the leg veins after surgery, Dr Emad prescribes one of these two depending on your risk. Take it at a fixed time, do not stop it on your own, and if bleeding will not stop or you see black stools or red urine, call the clinic right away, and if you get no answer, go to the emergency department.
- Famotidine or pantoprazole: One of these two medicines is prescribed to protect the stomach from pain relievers and aspirin. Take it as prescribed.
- Collagen: Collagen is a food supplement, not a medicine. In Dr Emad’s programme 10 g of collagen a day is recommended until the end of the third month after surgery; take it alongside your physiotherapy exercises, not instead of them.
- Alprazolam: This calming medicine is prescribed only in the first days, when needed. Do not combine alprazolam with oxycodone or acetaminophen with codeine on your own; combining it with any opioid pain medicine can cause severe sleepiness and dangerously slow breathing. If both are prescribed, clarify the plan with your doctor or pharmacist before taking them together. If you already take alprazolam regularly, do not stop it suddenly.
- Gabapentin: In Dr Emad’s programme, gabapentin is sometimes prescribed alongside pain relievers to reduce pain after surgery. Do not stop this medicine suddenly.
- Acetaminophen with codeine: This tablet contains codeine, an opioid pain medicine; take it only when you are in pain, and for as long as you are taking it, do not take any other medicine that contains acetaminophen, such as a cold tablet, syrup or powder. This tablet may cause constipation. If you are breastfeeding, tell your doctor before taking it.
- Oxycodone: Take this opioid pain medicine only if it is on your prescription and you need it; it is usually not needed for more than a few days. Do not take alprazolam on a day when you take oxycodone, and do not drink alcohol. If you already take alprazolam regularly, agree a pain medicine plan with your prescriber before starting oxycodone; do not abruptly stop alprazolam in order to take this pain medicine.
- Vitamin D: Vitamin D helps the body absorb calcium, and calcium is needed to build bone; the new ligament heals into this bone. In Dr Emad’s programme 1000 to 2000 units a day are taken for 3 months; do not take more than this.
- Vitamin C: The body needs vitamin C to make collagen and to heal wounds and tissue. In Dr Emad’s programme 1000 milligrams of vitamin C a day are taken for 6 weeks.
- Write down each medicine and the time of each dose, and if a dose is missed, do not double the next one.
- Do not add a new medicine, supplement or herbal product without asking your doctor or pharmacist, because it may interact with your clot-prevention medicine.
- While you are taking alprazolam, gabapentin or an opioid pain medicine, do not drive and do not drink alcohol, and keep opioid pain medicines out of children’s reach. If severe sleepiness or slow breathing occurs, the people with you must call emergency services right away; the emergency number is in the “Seek emergency help” box in the warning signs section.
🧊 Managing pain and swelling
Some swelling, bruising and warmth around the knee is common at first. The overall trend should be towards improvement. If today’s activity leaves pain or swelling clearly worse the next morning, reduce the amount of activity by one step.
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- For the first days at home, one practical plan is to apply a cold pack to the knee three times during waking hours each day, for 15 to 20 minutes per session. Fit the icing after exercise and walking into these three sessions, and do not add extra sessions for activities close together. You do not need to wake from sleep to apply the cold pack. Keep a thin cloth between the pack and your skin, and do not exceed 20 minutes per session.
- Check skin colour and sensation after each session. Marked whitening, persistent numbness or burning pain means remove the pack and wait until the skin is normal before using it again.
- When resting, place the calf and heel on several pillows so the knee is above heart level. Do not put the pillow directly behind the knee; the knee needs an opportunity to regain full extension.
- A compression wrap should support the leg, not squeeze it. The toes should remain warm, pink and normally sensitive; loosen a wrap that is too tight.
- Do not stay completely still. Alternate rest with brief, regular movement to reduce knee stiffness and sluggish circulation.
🚶 Walking, brace and everyday activity
From day one you walk with crutches and put as much weight on the operated leg as pain allows. In Dr Emad’s programme, because your meniscus was also repaired, crutches are needed for 5 to 6 weeks. If a complex (radial, root or horizontal) meniscal tear was repaired, put no weight on the operated leg until the end of week six and follow the complex-repair version of this guide. Every patient is given a brace: locked straight for walking and for sleeping, opened for range-of-motion exercises, and left off from week four. The early goal is short, safe walks without a limp.
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- Take several short walks through the day. When turning, use small steps; do not pivot on the operated leg or change direction suddenly.
- Do not stop using the crutches simply because a date has arrived. In Dr Emad’s programme, with a meniscal repair, 5 to 6 weeks is the usual figure, but the real condition is that you can tighten the muscle at the front of your thigh firmly, keep the knee straight while walking, and walk without a limp or increased pain or swelling. Drop one crutch first, then the second a few days later.
- On stairs, lead with the sound leg going up. To go down, hold the rail with one hand and a crutch with the other. Put the crutch on the lower step first, then place the operated leg and finally the sound leg on that same step. Control your weight through your hands and do not put more than the permitted weight on the operated leg.
- Begin ankle pumps (gently pointing the foot up and down) and tightening of the muscle at the front of the thigh (the quadriceps) in several short sessions during the first days. Keep the knee straight when resting and do not place a pillow directly underneath it.
- Keep pathways at home clear and well lit. Remove loose rugs and cables, keep essentials within reach and switch on a light for night-time trips to the bathroom.
🦾 PRP injections: a treatment made from your own blood
In Dr Emad’s programme, alongside your exercises, platelet-rich plasma (PRP) injections are used: a treatment made from your own blood to help the knee heal.
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- Help from your own blood: Platelet-rich plasma (PRP) is a part of your own blood in which the platelets have been concentrated, and it can help your body heal. Platelets carry hundreds of proteins called “growth factors” that are very important in healing injuries. To prepare PRP, a small amount of your blood is drawn and spun in a machine to separate the platelets and increase their concentration. This concentration varies with the preparation method and can reach 5 to 10 times the usual level. This fluid, made from your own blood, is then injected into the knee.
- What research found about PRP: In a trial involving 120 patients after ACL reconstruction, PRP injections into the knee were compared with no injection. Patients who had a meniscus repaired during the same operation were not included, so the result does not establish the effect of PRP after ACL reconstruction combined with meniscal repair. There was no statistically significant advantage for PRP in the study's main measure: knee symptoms and function at 12 months. Some imaging and sports activity outcomes were better at six months, but these secondary findings are not enough to establish a definite benefit. This study does not establish more reliable tissue healing or an earlier return to sport for every patient.
- Less pain in the first months: In a review of 24 trials, knee pain three months after surgery was significantly lower in the PRP group. In these studies PRP was given during surgery or shortly afterwards.
- If your meniscus was also repaired: Parts of the meniscus, the cartilage cushion inside the knee, get little blood; PRP brings the growth factors of your own blood right into the knee. Research is still ongoing, and every body responds a little differently.
- PRP at Dr Emad’s clinic: In Dr Emad’s programme, PRP is given as an injection into the knee after surgery, not during the operation. It is usually injected 2 times after an ACL reconstruction on its own, and 2 to 3 times if the meniscus was also repaired. The first injection is given about 2 weeks after surgery, and the spacing between injections is set according to your condition and the treatment team’s judgement. Whether PRP suits you is decided according to the condition of your knee.
🛡️ First two weeks
During the first two weeks, the goals are to control pain and swelling, keep the knee able to straighten and activate the front-thigh muscle. Start simple movements and short walks with the prescribed aid; do not pivot on a planted foot or place a pillow directly under the knee.
Each exercise carries its own starting condition on its own card. Reduce activity if pain or swelling is worse by the next day. The brace stays locked for walking and is opened for range-of-motion exercises; it is left off altogether at week four. With your meniscal repair, the crutches are left off between weeks five and six, once you walk without a limp. Wherever you see “the reference rehabilitation protocol”, that means the published programmes listed in this article’s sources.
1) Ankle Pumps
Moving the ankle keeps the calf muscles active during the low-movement period. From the first hours after you are alert, 15 repetitions every waking hour. Stop if you develop new calf pain or tightness, new or increasing swelling in one leg, new local warmth or redness, or shortness of breath, and act immediately as described in the warning-sign section.
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Before you start: Moving the ankle keeps the calf muscles active while you are less mobile and helps blood return from the leg. From the first hours after you are alert, lie on your back or recline with your calf and heel supported and your brace in its prescribed position. No equipment is needed; free the ankle from the bedclothes.
How to do it:
- Keep the thigh and knee still; only the ankle is meant to work.
- Draw the toes slowly toward your face until you feel a mild stretch behind the calf.
- Without rotating the leg, point the toes away from you.
- Return to the middle position and start the next repetition without any jerk.
Movement tips: Move only the ankle, slowly and steadily; keep the thigh and knee still and do not rotate the leg. Breathe freely and do not force the end of the movement. A mild calf stretch is expected; if the calf becomes tired, rest briefly and elevate the leg, with the support under the calf and heel, not under the knee.
Amount, repetitions and progression: In the reference rehabilitation protocol, 15 repetitions every waking hour. Do not drop this exercise; keep it up during long periods of sitting and travel.
Stop immediately if: you develop new calf pain or tightness, new or increasing swelling in one leg, new local warmth or redness, or shortness of breath; the warning-sign section explains what to do.
Common mistakes: Fast, jerky movement, holding the breath, and rotating the whole leg instead of moving the ankle.
Easier version: Make the range smaller and move only as far as is comfortable; even a short movement beats staying still.
2) Tightening the front thigh muscle without moving the knee (Quadriceps Set)
Activates the front thigh muscle so the knee can stay straight. 12 repetitions, three times a day. Stop if you develop sharp knee pain, or the knee swells more than it did before the exercise.
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Before you start: This exercise helps reactivate the front-thigh muscle and control a straight knee. From the first day, lie on your back on a firm bed with the operated leg straight and toes pointing toward the ceiling. Protect the wound and brace; resting a hand on your thigh helps you feel the contraction.
How to do it:
- Keep the toes pointing up and do not rotate the leg.
- Tighten the front thigh muscle; the kneecap usually moves slightly upward.
- Bring the back of the knee closer to the bed without lifting the heel.
- Hold the contraction for 5 seconds, feeling the muscle tighten under your hand, then release slowly.
- Let the muscle relax completely before the next repetition.
Movement tips: Keep the knee straight and heel on the bed; a visible muscle tightening or slight kneecap movement indicates contraction. Breathe out as you tighten and fully relax between repetitions. Brief thigh fatigue is expected; do not squeeze the buttocks instead of the thigh or open the brace without instructions.
Amount, repetitions and progression: In the reference rehabilitation protocol, 12 repetitions three times a day. Hold each contraction for 5 seconds, feeling the muscle tighten under your hand, then release it. If pain lasts into the next day or increases, reduce the number of sessions. Once the contraction is clear and the knee stays straight while you tighten, move on to the straight leg raise.
Stop immediately if: you develop sharp knee pain, or the knee swells more than it did before the exercise.
Common mistakes: Pushing with the buttock instead of the thigh, holding the breath, lifting the heel off the bed, and not releasing the muscle fully between repetitions.
Easier version: Use a shorter, gentler contraction, or rest your hand on the thigh so you can feel it working; if you still cannot tighten the front thigh muscle, tell your physiotherapist.
3) Heel Prop
Uses the lower leg’s weight to help the knee straighten. Dr Emad’s clinic programme includes about 5 minutes of gentle stretch. Stop if you develop pins and needles, numbness, a colour change in the foot or sharp pain; if it does not settle once you take the leg off the support, follow the warning-signs section.
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Before you start: The aim is to restore straightening of the operated knee. From the early days, lie on your back or recline. Place a folded towel or firm pillow under the heel only, leaving the knee unsupported and toes pointing up. In this version the meniscal repair does not limit knee bend, and this exercise is the one written for the reconstruction alone.
How to do it:
- Place the heel on the support so the back of the knee touches nothing.
- Let the thigh muscles go completely; this exercise works by relaxing, not by forcing.
- Allow the weight of the lower leg to draw the knee slowly toward straight.
- Do not press the knee down with your hand or a weight.
- To finish, use the sound leg to help the operated leg off the support.
Movement tips: Let the lower leg’s weight create a gentle stretch behind the knee; do not push the knee backward or put a weight on it. Breathe calmly and remain still. Between sessions, rest the leg comfortably and move the ankle. The knee should gradually straighten further, without sharp pain. If the knee is slow to straighten, do the same stretch lying face down as well: lie on your front on the bed with the thigh supported to just above the kneecap and the lower leg hanging over the edge, and let its weight open the knee slowly. In that position the muscle must be completely relaxed, and put nothing under the ankle.
Amount, repetitions and progression: In Dr Emad’s clinic programme, about 5 minutes of gentle stretch per session, and 20 to 30 minutes in the prone version. Do this stretch two to three times a day. Do not increase the time or the pressure yourself; once the knee is as straight as the other leg, hold on to that range.
Stop immediately if: you develop pins and needles, numbness, a colour change in the foot or sharp pain, especially behind the knee; if it does not settle once you take the leg off the support, follow the warning-signs section.
Common mistakes: Putting the support under the knee itself instead of the heel, pressing the knee down by hand, and keeping the thigh tight the whole time.
Easier version: Use a lower support or halve the time; if the back of the knee is sensitive, stay there only a few seconds at first.
4) Heel Slides
Helps restore knee bending within the permitted range. In the reference rehabilitation protocol, 10 to 20 repetitions, three to four times a day, within that week’s permitted range. Stop if you develop sharp pain or a locking or catching sensation. If sharp pain, locking or catching does not settle after stopping, follow the warning-signs section.
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Before you start: This movement restores knee bending within the permitted range and is used from the early days of rehabilitation. Lie on your back on a bed or a clear, level floor, with the operated heel on a towel or sliding surface, pelvis level and toes pointing up.
How to do it:
- Slide the heel slowly toward your buttock; if you cannot manage it on your own, loop a sheet or long towel around the foot and help gently with your hands.
- Keep the knee in line with your toes and do not let it fall inward.
- In this version, bend the knee gently within a mild, tolerable stretch and pause briefly; do not force it further. The 90- and 120-degree figures in the dose paragraph are progress goals, not limits for this movement; follow any individual restriction your surgeon has given you.
- Slide the heel back under control until the knee is fully straight.
- Take one calm breath before the next repetition.
Movement tips: Move only within your permitted range, without rotating the leg or moving the pelvis. Breathe out as you bend and in as you return; a mild stretch is acceptable, sharp pain is not. Rest with the leg straight between sessions. For a hamstring graft, the reference rehabilitation protocol uses a towel or sheet to assist so the hamstrings do not contract actively. Learn the assistance technique from your physiotherapist and do not force the knee to bend.
Amount, repetitions and progression: In the reference rehabilitation protocol, 10 to 20 repetitions, three to four times a day. The goal is 90 degrees by week two and 120 degrees by week four; do not force the knee to reach these angles sooner. If clear swelling remains after exercise, reduce the range.
Stop immediately if: you develop sharp pain or a locking or catching sensation; if the sharp pain, locking or catching does not settle once you stop the exercise, follow the warning-signs section.
Common mistakes: Pulling the sheet suddenly and hard, lifting the pelvis off the bed, rotating the foot outward, and snapping back to straight.
Easier version: Use a shorter range, or use the sound leg behind the operated leg to keep the movement controlled.
5) Straight Leg Raise
Keeping the knee straight while lifting the leg shows front-thigh muscle control. 12 repetitions, three times a day. Stop if the knee bends during the movement, you develop sharp pain, or you feel a painful stretch behind the knee. If it does not settle after resting the leg on the bed, follow the warning-signs section.
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Before you start: Lifting the leg with a straight knee practises front-thigh muscle control. Start once the muscle contracts clearly and the knee stays straight while you tighten it, usually from day two or three. Lie on your back on a firm surface, with the sound leg bent and its foot on the bed, and the operated leg straight with toes pointing up. Keep the brace fastened and have someone beside you for the first sessions.
How to do it:
- Tighten the quadriceps fully so the knee stays firm and straight.
- Check that the knee is straight before you lift.
- Lift the whole leg as one piece, a few centimetres, without the knee bending.
- Pause briefly and keep the pelvis still.
- Lower the leg slowly and release the muscle before the next repetition.
Movement tips: Lift only as high as you can keep the knee straight and pelvis still; do not arch your back or swing the leg. Breathe out to lift and in to lower. Rest the leg on the bed and relax the thigh between sessions. Mild front-thigh fatigue is expected; sharp pain or a painful stretch behind the knee is not.
Amount, repetitions and progression: In the reference rehabilitation protocol, 12 repetitions three times a day. If pain or swelling increases after exercise, reduce the repetitions. Add an ankle weight once you can do the 12 repetitions smoothly and without the knee bending, and start with the lightest weight you have.
Stop immediately if: the knee bends during the movement, you develop sharp pain, or you feel a painful stretch behind the knee; if it does not settle once you rest the leg on the bed, follow the warning-signs section.
Common mistakes: The knee bending as you lift, arching the lower back, jerking or swinging the leg, and helping with a hand under the thigh.
Easier version: Go back to the quadriceps set, or lift even less than a few centimetres so the knee stays straight.
6) Assisted Seated Knee Flexion
The knee bends under the lower leg’s weight, with the sound leg helping it bend and return. 10 to 20 repetitions, three to four times a day, within that week’s permitted range. Stop if you develop sharp or persistent pain, a feeling of locking or catching in the knee, numbness, pins and needles or dizziness.
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Before you start: This exercise helps bend the knee using the lower leg's weight and the sound leg. In the second week, if you can sit without dizziness and heel slides have not caused next-day swelling, sit on a high, firm bed. Support the thighs almost to the knees and let the lower legs hang; place a folded towel under the thighs if the edge presses on them. In this version you have no extra range restriction; the range-progress goal is the same as for heel slides: 90 degrees by the end of week two and 120 degrees by the end of week four.
How to do it:
- Sit tall and do not lean back.
- Release the front-thigh muscle so the lower leg drops under its own weight and the knee bends.
- Rest the sound shin in front of the operated shin and add light, gradual pressure backwards until you feel a tolerable stretch.
- Pause a few seconds at the permitted limit, then ease off the pressure slowly.
- Hook the sound ankle from behind, under the operated ankle, and lift the lower leg back up to straight.
Movement tips: The sound leg should assist the operated leg with only gentle pressure. Stay within the permitted range and do not rotate the pelvis or leg. Breathe out while bending and in while returning, moving slowly both ways. Relax the lower legs between sessions. Movement should be smooth and the stretch should ease when released. Persistent pain or pins and needles mean you should not continue; next-day swelling means the amount was too much, so reduce the range.
Amount, repetitions and progression: In Dr Emad’s clinic programme, 10 to 20 repetitions, three to four times a day, pausing a few seconds at the permitted limit each time. The range goal is the same as in the heel-slide exercise: 90 degrees by the end of week two and 120 degrees by the end of week four. Compare how far the knee bends with last time, not how hard you push. You do not have to go further at every session. If the knee swells after exercise, reduce the range.
Stop immediately if: you develop sharp or persistent pain, locking or catching, numbness or pins and needles, especially behind the knee, or dizziness when sitting up; if you feel dizzy, lean back or lie down and do not get off the bed without help; if the sharp pain, numbness, pins and needles or locking does not settle once you stop the exercise, follow the warning-signs section.
Common mistakes: Pushing hard or jerkily with the sound leg to the point of pain; lifting the leg with the operated thigh instead of the sound leg; and sitting on a low bed where the feet reach the floor.
Easier version: Shorten the time, or keep the sound ankle hooked under the operated one from the start so it carries part of the weight.
7) Multi-Direction Straight Leg Raise with Brace
Raise the straight leg outwards and inwards. The brace must be fastened and the knee must stay straight throughout. 12 repetitions in each direction, one to three times a day. Stop if the knee bends inside the brace, you develop sharp pain, or the brace slips or twists.
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Before you start: This exercise works the hip muscles while keeping the knee straight. Start with the prescribed brace fastened once forward straight-leg raises can be performed without knee bending or next-day swelling. Use a firm bed or mat with a pillow under your head and have someone with you initially. Lie on the sound side for the outward lift and on the operated side for the inward lift.
How to do it:
- Before lifting, tighten the front-thigh muscle so the knee stays straight as the leg rises.
- Lying on the sound side, lift the operated leg straight and a few centimetres up; keep the toes pointing forward and do not roll the leg toward the ceiling.
- Pause briefly, then lower the leg slowly without letting the pelvis rotate.
- For the inward lift, lie on the operated side. Bend the sound leg and place its foot on the bed in front of you. Lift the straight operated leg underneath slightly off the bed, then lower it slowly.
Movement tips: Practise only outward and inward lifts at this stage. Lift a short distance without swinging; keep the pelvis still and the toes forward, and stop the brace from rotating. Breathe out to lift and in to lower, relaxing the leg between sessions. Side-hip fatigue in the outward direction and inner-thigh fatigue in the inward direction are expected; the knee should not hurt. The backward leg lift is added from week four and is done lying face down. If the graft was taken from the hamstrings, week four is also the earliest it may start.
Amount, repetitions and progression: In Dr Emad’s clinic programme, 12 repetitions in each direction, one to three times a day. If pain or swelling increases the next day, reduce the repetitions. Add an ankle weight once you can do the 12 repetitions smoothly and without the knee bending, and start with the lightest weight you have.
Stop immediately if: the knee bends inside the brace, you develop sharp pain, particularly in the knee or groin, or the brace slips or rotates during movement; if the brace slips or rotates, before any further repetition, re-fasten the brace straight and tight, and if it slips again or the knee does not stay straight, set the exercise aside and contact your care team. If you get sharp pain, stop there, and contact your care team if it does not settle with rest.
Common mistakes: Rolling the toes toward the ceiling on the outward direction; letting the pelvis rotate to lift the leg higher; arching the lower back; and strapping the brace loosely.
Easier version: Reduce the height, or do only the outward direction for now. If lying on the operated side hurts, postpone the inward direction.
↔️ Second two weeks
If swelling is controlled and movement quality is satisfactory, range and walking improve during these two weeks. In this version, the wall squat and mini squats start from week four, to a depth of up to 30 degrees; after that the depth increases in steps; the wall-squat exercise gives the details of how depth increases.
Once the knee bends to at least 90 degrees, usually from the end of week two, the stationary bicycle starts with a high saddle and low resistance. This stage is not clearance to return to running.
8) Calf muscle stretch (Gastroc–Soleus Stretch)
Stretches the calf muscles so the ankle can bend more easily. When you feel a gentle stretch in the back of your calf, hold it for 30 seconds; then release it fully and rest for 30 seconds. Repeat several times on each leg. Stop if you develop sharp calf pain, pins and needles or numbness in the sole, or if knee pain increases.
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Before you start: This stretch helps calf flexibility and easier ankle movement. Start in the early weeks if sitting with a straight leg or standing with support is possible and permitted. When seated, loop a towel around the operated foot; when standing, face a wall with the operated leg behind you. Use a non-slip surface and closed shoes.
How to do it:
- In the seated version, pull the towel gently toward you so the toes come toward your face; in the standing version, with the heel of the back foot on the floor, shift your weight slowly toward the wall until you feel the stretch in the back of the calf.
- Keep the knee straight so the stretch reaches the upper calf muscle (gastrocnemius).
- Hold the mild stretch without bouncing or pushing suddenly.
- Then repeat the stretch with the knee slightly bent to stretch the deeper calf muscle, the soleus.
- Release slowly and take a breath before the next repetition.
Movement tips: Hold a gentle, steady stretch within your tolerance and breathe freely. Do not rotate the foot; keep the heel on the floor when standing and avoid stressing the knee. Fully relax the leg between repetitions. A mild calf stretch and easier ankle movement after release are expected.
Amount, repetitions and progression: When you feel a gentle stretch in the back of your calf, hold it for 30 seconds; then release it fully and rest for 30 seconds. Repeat several times on each leg, two to three sessions a day. Once the ankle bends comfortably in squatting and walking, keep the same stretch as a warm-up.
Stop immediately if: you develop sharp calf pain, pins and needles or numbness in the sole, or knee pain increases during the stretch; if the calf pain, pins and needles or numbness does not go away when you release the stretch, follow the warning-signs section.
Common mistakes: Bouncing the stretch, rotating the foot to get more of it, lifting the heel in the standing version, and forgetting the bent-knee version.
Easier version: Do a shorter, gentler stretch, or do only the seated towel version until standing for longer is comfortable.
9) Stationary Bike
Stationary cycling is a low-impact exercise that helps smooth knee movement and improve fitness. In the reference rehabilitation protocol it starts at low or zero resistance and at 5 minutes, and builds gradually to 20 minutes a session. Stop if you have sharp pain or knee catching, develop front-of-knee pain, or move the pelvis up and down to pedal.
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Before you start: A stationary bike helps smooth knee movement and restore fitness. Start the bike once the knee bends to at least 90 degrees, usually from the end of week two. Choose a stable bike with a relatively high saddle. Use support to mount. Adjust the saddle so the knee is nearly straight at the bottom of the pedal stroke and the pelvis stays still.
How to do it:
- Start with the lowest resistance.
- Turn the pedals slowly and evenly.
- If a full revolution is not yet possible, rock the pedal forwards and backwards as far as it goes until the range improves.
- Keep the pelvis still and the knee tracking forward; the pelvis must not move up and down with each revolution.
- Slow down gradually, then get off using the support.
Movement tips: Pedal slowly and evenly, breathing normally. Do not stand on the pedals or use heavy resistance. Lower the saddle only within your permitted range and keep the pelvis from shifting each revolution. If a long session is tiring, shorten it and elevate the leg between sessions. Pedalling should be smooth and should not cause next-day swelling.
Amount, repetitions and progression: In the reference rehabilitation protocol, you start at low or zero resistance and at 5 minutes, and raise the time slowly until you reach 20 minutes a session; raising the resistance begins at about week five to six. Pedal once or twice a day. At each step raise only one of the two — time or resistance — never both together. If pain or swelling increases the next day, go back to the previous amount and review the plan with your physiotherapist.
Stop immediately if: you develop sharp pain or knee catching, front-of-knee pain begins, or you move the pelvis up and down to pedal.
Common mistakes: A saddle set too low, heavy resistance from the start, pedalling while standing, and pushing on through front-of-knee pain.
Easier version: The permitted back-and-forth movement, zero resistance, or less time; even a few minutes is an acceptable start.
10) Heel and Toe Raises
Heel and toe raises strengthen the muscles at the back and front of the lower leg in standing: the same muscles that drive the body forward in walking and keep the toes lifted off the floor. Two sets of 12, once a day, keeping a hand on the support. Stop if balance is not safe, the knee or ankle hurts sharply, or the calf develops a cramp.
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Before you start: This standing exercise strengthens the muscles at the front and back of the lower leg. After weight-bearing is permitted and you can stand on both feet without sharp pain, face a fixed counter or rail. Wear closed shoes on a non-slip surface, place your feet hip-width apart and rest your hands lightly on the support.
How to do it:
- Pressing evenly through both feet, lift the heels slowly off the floor.
- Pause at the top for a moment and do not let the ankles roll outward.
- Lower the heels slowly and under control.
- Then shift the weight slightly back and lift the toes off the floor.
- Lower the toes gently and begin the next repetition.
Movement tips: Both feet should work together and equally. Keep the knees almost straight and do not roll the ankles. Rise only as far as you can balance. Move slowly, breathing out to rise and in to lower. Stand and relax the calves between sets. Mild fatigue is expected, but do not continue through cramp.
Amount, repetitions and progression: In the reference rehabilitation protocol, two sets of 12 on both legs, once a day. The single-leg version is 12 repetitions twice a day, and starts once the double-leg repetitions are smooth and even and you no longer need support.
Stop immediately if: you are unsure of your balance or lose balance, develop sharp knee or ankle pain, or experience calf cramp.
Common mistakes: Hanging on the hands, shifting weight to the sound leg, letting the ankle roll outward at the top, and dropping the heels suddenly.
Easier version: Less height or more contact with the support; if needed, do only half the range at first.
11) Wall Squat
With support from the wall, strengthens the quadriceps in a shallow, fully controlled range. 12 repetitions to the depth allowed in that week, one to three times a day. Stop if the knee hurts or gives way, or shaking disrupts movement control.
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Before you start: A wall squat strengthens the front-thigh muscles, with the wall helping your balance. Start after weight-bearing is permitted, swelling is controlled and you can walk without a limp; with your simple meniscal repair, start this exercise from week four, to a depth of up to 30 degrees. Wear closed shoes on a non-slip surface and stand against a flat wall, feet hip-width apart and slightly forward, with your back and buttocks touching the wall. Use a ball behind your back only if your physiotherapist recommends it.
How to do it:
- Share the weight across both whole feet.
- Slide your back down the wall and lower yourself slowly.
- Go down only within your permitted range; the knees must not travel past the toes.
- Keep the knees over the line of the second toe and do not let them fall inward.
- In the static version of this exercise, instead of going down and up, stay at the permitted depth until you feel mild thigh fatigue, then stand up; repeat this hold 12 times.
- Press up evenly through both feet, without pushing off with your hands.
Movement tips: Lower only a short distance within your allowed range. Keep the heels down, weight equal on both legs and knees aligned with the feet. Breathe in to lower and out to rise; breathe freely during holds. Stand upright and relax the thighs between sets. You should feel the front-thigh muscles working. Stop if the knee itself hurts or shaking disrupts control.
Amount, repetitions and progression: 12 repetitions, one to three times a day. Start shallow and raise the depth in steps. The ladder the 2024 meniscus rehabilitation consensus gives for a repaired meniscus is your own rule in this version: up to 30 degrees in weeks four to eight, up to 45 degrees in weeks eight to twelve, and up to 60 to 90 degrees in weeks thirteen to sixteen. If the knee swells after exercise, reduce the depth or the repetitions.
Stop immediately if: the knee hurts, the knee gives way, or shaking disrupts your control of the movement.
Common mistakes: Going deeper than permitted, letting the knee travel past the toes, letting the knees fall inward, lifting the heels, and holding the breath in the static version.
Easier version: Less depth or a shorter hold; you can start by going down only a few centimetres and coming straight back up.
🌱 Month 2: days 31–60
Goals are to maintain full extension, advance flexion gradually, walk without a limp, control swelling and build muscle strength. Moving past this stage depends on good movement quality and on pain and swelling not increasing after exercise; reaching day 60 is not enough on its own.
12) Supported Mini Squat
Helps distribute weight evenly between both legs. 12 repetitions to a depth of 30 degrees, one to three times a day. Stop if you develop sharp knee pain or a sensation of the knee giving way, or shaking disrupts movement control.
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Before you start: With a mini squat, you practise sharing weight between both legs. Start once weight-bearing is permitted, swelling is controlled and you walk without a limp; with your simple meniscal repair, start this exercise from week four, to a depth of up to 30 degrees. Wear closed shoes on a dry, non-slip surface and face a fixed counter or rail, with feet hip-width apart and both feet flat.
How to do it:
- Rest your hands lightly on the support; do not hang from it.
- Take the hips back slightly, as if you were about to sit.
- Bend the knees only within the permitted range.
- Keep the knees in line with the toes and the weight on both legs.
- Press up slowly and evenly through both feet.
Movement tips: Keep the movement shallow and within your plan, with a level pelvis, heels down and similar pressure through both feet. Lower slowly while breathing in and rise slowly while breathing out. Stand upright between sets. Mild thigh fatigue is expected, but rest if shaking disrupts control.
Amount, repetitions and progression: 12 repetitions, one to three times a day. The depth at this stage is up to 30 degrees, that is, the knee bends only slightly. If the knee swells the next day, reduce the depth or the repetitions.
Stop immediately if: you develop sharp knee pain, a sensation of the knee giving way, or shaking disrupts your control of the movement.
Common mistakes: The knee falling inward, shifting weight to the sound leg, hanging on the hands, and lifting the heels.
Easier version: Use less range or take more support from your hands, but still do not hang from the support; you can start by practising the weight shift alone, without bending the knees.
13) Double-Leg Bridge
Strengthens the buttocks and back of the thigh. 12 repetitions, one to three times a day. Stop if you develop pain in the knee, the back of the thigh, the lower back or the neck, or a persistent cramp.
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Before you start: A double-leg bridge works the buttock and back-of-thigh muscles. Once swelling is controlled and lying down and bending the knee within the permitted range are comfortable, lie on your back on a firm mat. Bend the knees and place both feet flat, hip-width apart. If you have a hamstring graft, do not start this exercise before week four.
How to do it:
- Tighten the abdominal muscles very gently so the lower back does not arch.
- Pressing evenly through both feet, lift the buttocks off the floor.
- Raise the hips until the shoulders, hips and knees are in a straight line, no higher.
- Pause briefly without arching the lower back.
- Lower slowly and gradually, from the top of the lower back down to the pelvis.
Movement tips: Lift only until the shoulders, hips and knees align; do not arch the back or let the knees spread outward. Breathe out to lift and in to lower. Rest the pelvis on the floor and relax the muscles between sets. Keep pressure equal through both feet and feel the work in the buttocks and the back of the thigh, not the back or neck.
Amount, repetitions and progression: 12 repetitions, one to three times a day, pausing for a moment at the top. Start the single-leg version once you can do 12 double-leg repetitions with the pelvis completely level.
Stop immediately if: the knee hurts, the back of the thigh hurts (especially if the graft was taken from the hamstrings), the lower back or neck hurts, or hamstring cramp persists.
Common mistakes: Arching the back to lift higher, pressing into the neck and shoulders, letting the knees splay outward, and loading the sound leg more.
Easier version: Reduce the height or shorten the hold; you can start by simply tightening the buttocks without lifting the hips at all.
14) Low Step-Up
Strengthens the quadriceps in standing and helps you control the knee when climbing a step. 12 repetitions on each leg, on the lowest step you have. Stop if the knee gives way or hurts sharply.
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Before you start: Stepping up trains the front-thigh muscle and knee control. Once you walk without an obvious limp and perform a mini squat correctly, start with a permitted low step. It must be stable, non-slip and beside a rail; wear closed shoes. Face the step, place the entire operated foot on it and keep a hand near the rail.
How to do it:
- Transfer the weight gradually onto the operated leg.
- Keep the knee pointing in the same direction as the toes and do not let it fall inward.
- Press through the whole foot and come up without any hop.
- At the top, level the pelvis and stand still for a moment.
- To come down, lower the healthy leg to the floor first and slowly; the operated leg stays on the step and controls the descent until that foot touches down.
Movement tips: The step must not be high enough to cause pain or the knee to fall inward. Keep the pelvis facing forward and level. The back leg should help balance without pushing you up. Breathe out to rise and in to lower more slowly. Stand or sit between sets to let the thigh relax.
Amount, repetitions and progression: In the reference rehabilitation protocol, 12 repetitions on each leg, one to three times a day. Start with the lowest step you have and, once you go up and down smoothly without using your hands, move to an ordinary stair step. If the knee swells after exercise, reduce the height or the repetitions.
Stop immediately if: the knee gives way or you develop sharp pain.
Common mistakes: Hopping off the back leg, placing only half the foot on the step, letting the knee fall inward, and coming down by suddenly releasing the weight.
Easier version: Choose a lower step or take more help from the rail; you can start by practising only the weight transfer onto the step.
15) Single-leg balance with a support within reach
Trains joint-position sense and hip and knee control. Several sessions on each leg, for as long as you can stand without touching the support. If the knee gives way, you feel dizzy or you cannot stand safely, put the foot down and stop.
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Before you start: This exercise practises awareness of knee position and balance control. Start on a flat, non-slip surface once loading the operated leg is permitted and safe and you walk without a limp. Wear suitable shoes and stand beside a firm counter or rail, with the operated foot under the hip and the knee unlocked.
How to do it:
- Transfer the weight slowly onto the operated leg.
- Lift the other foot slightly off the floor.
- Keep the standing knee slightly bent and the pelvis level.
- Look at a fixed point in front of you.
- Put the foot down when you can no longer keep the hip and knee in the correct position.
Movement tips: For now, stay on a stable surface and breathe freely. Keep the pelvis level and rest the hand only lightly on the support. Small balance adjustments are expected, but large sways are not; if the sway becomes large, put the foot down and do the next repetition with more weight resting on the support. Stand on both feet between repetitions to relax the thigh and calf. Mild fatigue in the calf and sole may occur.
Amount, repetitions and progression: Several sessions on each leg, one to three times a day; quality matters more than duration. Use a balance board or half foam roller (a foam roller cut in half along its length) only after your physiotherapist has assessed this progression, set its timing and technique for you, and allowed it within your surgeon’s restrictions. Being able to stand steadily without touching the support does not by itself clear you for an unstable surface; continue on a stable surface until that progression has been prescribed for you.
Stop immediately if: the knee gives way, you feel dizzy or you cannot stand safely.
Common mistakes: Locking the standing knee, letting the pelvis drop to one side, leaning heavily on the hand, and moving to an unstable surface too soon.
Easier version: Take more help from the support, or keep both toes on the floor and practise only the weight shift.
16) Isolated Hamstring Curl
Strengthens the hamstrings separately. 12 repetitions, one to three times a day. Stop the movement immediately if you get sharp pain in the back of the thigh, pain at the graft harvest site, a hamstring cramp, or pain behind the knee. When a cramp occurs, let the leg relax; if the cramp is painful, do not continue that session.
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Before you start: This exercise strengthens the hamstrings. With a hamstring graft this exercise does not start before week four. With other grafts, start once bending the knee within the permitted range is pain-free. Stand facing a support with your weight on the sound leg, or lie face down on a bed. Start without weight and build up the band or machine from the lightest resistance.
How to do it:
- Keep the pelvis still and do not let the thigh swing forward as you move.
- Draw the heel slowly toward the buttock.
- Pause briefly within the permitted range.
- Return the leg slowly and under control to straight.
- Release the muscle completely before the next repetition.
Movement tips: Bend the operated knee slowly within the permitted range, without forcing the end position or moving the pelvis or back. Breathe out to bend and in to return. Fully relax the hamstrings between sets. Mild fatigue behind the thigh is expected. If the muscle cramps, stop the movement there and let the leg relax; do not continue that session with a painful cramp, and at the next session use less resistance and rest longer between sets. If the cramp comes back, tell your physiotherapist.
Amount, repetitions and progression: 12 repetitions, one to three times a day. If the graft was taken from the hamstrings, do not start this exercise before week four. Start without weight. If pain or swelling increases the next day, reduce the resistance by one step and stay there until the knee settles. Once 12 repetitions are complete and pain-free with no increase in next-day pain or swelling, add one step of resistance at a time.
Stop immediately if: you develop sharp pain in the back of the thigh, graft-harvest-site pain, hamstring cramp or pain behind the knee. When a cramp occurs, let the leg relax; if the cramp is painful, do not continue that session.
Common mistakes: Bringing the thigh forward to curl further, arching the lower back, letting the leg drop on the way back, and starting with heavy resistance.
Easier version: Start with no band and only the weight of the leg, or use a shorter range.
🏋️ Month 3: days 61–90
The focus shifts toward strength, single-leg control and greater activity tolerance. Sudden pivoting, contact sport and starting to run on your own are still inappropriate. In this clinic’s plan, all of the following conditions must be met before you start light straight-line jogging in weeks eight to ten. Range of motion must have returned to normal, and pain and swelling must be minimal. Your care team must have assessed your strength, movement control and how you walk, and approved you to start jogging. You must also follow the restrictions specific to your meniscal repair.
Because your meniscus was repaired, deep knee bending, jumping and twisting of the knee are left out for at least four months. Mini squats are the exception and have a ladder of their own: up to 45 degrees in weeks eight to twelve, and up to 60 to 90 degrees from week thirteen. So through the end of week twelve keep squat depth at 45 degrees (a chair at knee height is still too deep) and go deeper in steps from week thirteen. In Dr Emad’s programme, the lunge stays at 45 degrees until the end of month four.
17) Squat to Chair
Builds two-legged strength and control of sitting down and standing up: the movement you repeat dozens of times a day. 12 repetitions to the depth permitted that week, one to three times a day. Stop if you develop sharp knee pain or the knee gives way, or fatigue reduces movement control.
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Before you start: Controlled sitting and standing trains strength in both legs. Once you have mastered the mini squat without increased pain or swelling, place a firm chair without wheels against a wall. Wear closed shoes on a non-slip surface and stand with your back to the chair, feet hip-width apart and weight through the whole of both feet.
How to do it:
- Share the weight across both whole feet.
- Take the hips back and let the trunk come slightly forward.
- Keep the knees in line with the toes and lower within the permitted range.
- Make light contact with the chair; do not drop onto it.
- Press up evenly through both feet.
Movement tips: The chair must be high enough to sit within your permitted range. Keep the heels down and weight equal on both legs, touching the chair gently. Breathe in as you lower slowly and out as you stand. Sit or stand between sessions and relax the thighs. Do not continue when fatigue reduces control.
Amount, repetitions and progression: 12 repetitions, one to three times a day. In this version keep the depth at 45 degrees through the end of week twelve, that is, work with a chair higher than the knee; from week thirteen, once you can do 12 repetitions without dropping onto the chair and without using your hands, use a lower chair. If the knee swells after exercise, reduce the depth or the repetitions.
Stop immediately if: you develop sharp knee pain, the knee gives way, or fatigue reduces your control of the movement.
Common mistakes: Dropping suddenly onto the chair, the knees collapsing inward, shifting weight to the healthy leg, and lifting the heels.
Easier version: Use a higher chair, or rest a hand lightly on a counter so the path stays controlled.
18) Lateral Band Walk
Strengthens the side hip muscles so the knee does not fall inward when you walk. 12 steps in each direction, with the lightest band. Stop if you feel pain, the knee gives way, or you cannot keep the correct body position.
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Before you start: Sideways steps with a band train the side-hip muscles. Start after mastering single-leg balance and shallow squats with correct alignment. Place the band above the knees and start with the lightest resistance; placing it around the ankles loads the knee more and belongs to later stages. On a flat, clear path, keep the feet parallel and hip-width apart, knees slightly bent and band lightly stretched.
How to do it:
- Keep the band under slight tension so there is resistance the whole way.
- Take the hips back a little and keep the trunk still.
- Take a short step sideways.
- Bring the second foot in without letting the band go completely slack.
- Keep the toes and kneecaps pointing forward throughout.
Movement tips: Take short, equal steps in both directions. Keep the trunk from rotating or leaning sideways and the knees aligned with the feet. Breathe normally and move without bouncing. Release the band and stand upright between sessions. Mild fatigue or burning at the side of the hip is expected, but if this burning turns into pain, stop the exercise.
Amount, repetitions and progression: 12 steps in each direction, one to three times a day. Start with the lightest band and, once you can take 12 steps with the knee in line with the toes and the trunk steady, move to a firmer band. If the knee or the side of the hip swells or hurts after exercise, reduce the distance or the resistance.
Stop immediately if: the knee or side of the hip hurts, the knee gives way, or your body position changes clearly, for example if the toes turn or the trunk leans.
Common mistakes: Dragging the foot along the floor, taking long steps, letting the toes turn out, and leaning the trunk sideways to compensate.
Easier version: Use a lighter band, keep it above the knees rather than moving it to the ankles, and take shorter steps. Coordinate this change with your physiotherapist.
19) Controlled Step-Down
Strengthens the front thigh muscle to control body weight while stepping down. 12 repetitions on the operated leg on the lowest step you have, one to three times a day. Stop if you develop front-of-knee pain or giving way, or fatigue makes it hard to maintain knee alignment.
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Before you start: This exercise improves the front-thigh muscle's ability to control lowering your body. Start after mastering pain-free step-ups and squats with correct alignment. Wear closed shoes and stand on a low, stable step beside a rail, with the entire operated foot on the step, pelvis facing forward and a hand near the rail.
How to do it:
- Keep the weight on the operated leg.
- Keep the pelvis level and guide the knee of the operated leg in line with the toes.
- Bend the operated knee slowly so the other foot travels down.
- Let only the heel of the other foot touch the floor lightly; do not put weight on it.
- Return up by pressing through the operated leg, without any hop.
Movement tips: Choose a step low enough to prevent the pelvis dropping or knee falling inward. Breathe in as you lower slowly until the healthy foot touches the floor lightly and quietly; breathe out to return. Relax the thigh between sessions. Stop if fatigue makes alignment difficult to maintain. Raising the step too soon may increase pain at the front of the knee.
Amount, repetitions and progression: 12 repetitions on the operated leg, one to three times a day. Start with the lowest step you have and, once you can do 12 repetitions with the pelvis level and the knee in line with the toes, move to an ordinary stair step. If the knee swells after exercise, reduce the height or the repetitions.
Stop immediately if: the front of the knee hurts, the knee gives way, or fatigue makes keeping the alignment hard.
Common mistakes: The knee falling inward, the free-side pelvis dropping, pushing off with the other foot, and releasing the weight suddenly at the end of the range.
Easier version: A lower step or more help from the rail; you can start by going down only a few centimetres and returning.
20) Lateral Step-Up / Step-Down
Practises stepping up and down sideways; the knee should not fall inward during the movement. Practise with each leg on the short step specified in your physiotherapist’s plan. Stop if the knee gives way, hurts sharply, or falls inward even after you try to correct the movement.
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Before you start: In this exercise you practise knee control during sideways movement. Start after mastering forward step-ups and step-downs without pain and with correct alignment. Wear closed shoes and stand beside a low, stable step with a rail, operated leg nearest the step, pelvis facing forward and a hand near the rail.
How to do it:
- Place the whole operated foot on the step.
- Transfer the weight gradually onto that leg and keep the knee in line with the toes.
- Without pushing off with the other leg, press through the whole foot and come up.
- Stand still at the top for a moment and level the pelvis.
- Bend the operated knee slowly and lower the other leg under control to the floor.
Movement tips: Keep the step low. Do not let the knee fall inward, the free-side pelvis drop or the trunk lean sideways. Breathe out as you rise and breathe in as you lower more slowly. The healthy foot should touch the floor lightly. Relax the thigh and side-hip muscles between sessions so fatigue does not disrupt alignment.
Amount, repetitions and progression: Your physiotherapist should set the repetitions and sessions for this lateral step-up and down. Start with the same short step. If pain or swelling is greater the next day, reduce the repetitions and keep the same height. Increase height only after your physiotherapist assesses you and permits it; the pelvis must not drop, the knee must not fall inward and pain or swelling must not increase the next day.
Stop immediately if: the knee falls inward despite your attempts to correct it, or it gives way or hurts sharply.
Common mistakes: Pushing off with the healthy leg, leaning the trunk sideways, letting the free-side pelvis drop, and choosing a high step from the start.
Easier version: A lower step or more help from the rail; practise only the step-up first and add the step-down later.
21) Front and Side Lunge
Trains leg strength and control with one leg in front of or beside the body. 12 repetitions on each side, front knee to 45 degrees. Stop if the knee falls inward or gives way, hurts sharply, or you are not sure of your balance.
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Before you start: A lunge practises leg strength and control with one foot forward or to the side. In this guide it follows established single-leg control in the third month; pain-free chair squats and step work must be mastered first. Wear closed shoes and stand near a support in a flat, clear area, feet hip-width apart and trunk upright.
How to do it:
- For the front lunge, take a short step forward with the operated leg and land heel first; once the repetitions are done, do the same with the sound leg.
- Bend the front knee only within the permitted range and keep it in line with the toes.
- Press through the front foot to return to standing.
- For the side lunge, take a short step sideways with the operated leg and take the hips back while the other leg stays straight; do this on both sides too.
- Press through the outside foot to return to the starting standing position, keeping the trunk upright throughout.
Movement tips: Keep the step short and the movement shallow. At this stage, the front knee should not pass the toes or fall inward. Do not pivot on a planted foot. Breathe in to lower and out to return slowly without bouncing. Stand upright and relax the thighs between sessions. Return without wobbling and keep the knee aligned.
Amount, repetitions and progression: 12 repetitions on each side, one to three times a day. Take a step the length of a normal walking stride, and at first bend the front knee only to 45 degrees; in Dr Emad’s programme, in this version the lunge stays at 45 degrees until the end of month four. After month four, if you have trained for several sessions without wobbling and pain or swelling has not increased the next day, go on to 90 degrees. If pain or swelling increases the next day, reduce the depth or the repetitions.
Stop immediately if: the knee falls inward, hurts sharply or gives way, or you are unsure of your balance.
Common mistakes: A long step, the knee falling inward, the trunk folding forward, landing on the toes instead of the heel, and going straight to a deep lunge.
Easier version: A shorter step and less depth, or performing the movement beside a wall with one hand on a support.
🎯 Continuing the running programme and returning to sport
A return to pivoting sport does not happen before six months and, beyond the time, requires these criteria: no pain or swelling, full and symmetrical range of motion, knee stability on examination, quadriceps and hamstring strength at least 90 per cent of the sound leg, squatting and landing with the knee in line, hop testing, and psychological readiness. In a study of young athletes, returning before nine months was associated with a higher rate of a second tear. In the American Academy of Orthopaedic Surgeons (AAOS) guideline, a test of how well you perform a movement, such as a hop test, may be considered as one factor in this decision. The guideline itself gives that statement with limited evidence, so no single test result is on its own a clearance to return.
In a study of athletes aged 15 to 30, those who returned to knee-strenuous sport before 9 months had more second ACL injuries during follow-up than those who returned later. Over the same follow-up, second injuries in the group that returned early were several times more common than in the group that returned later; the researchers reported that difference as a figure of about 6.7, using a measure called a hazard ratio. The number does not predict your own probability of injury, and because the study was only observational it does not prove cause either. Both healing time and strength and movement-control criteria should guide return; reaching 9 months alone is not enough.
Jump training lands with a deep bend and the change-of-direction programme twists the knee; both are on that same list, so in this version they do not start before the end of month four. Light straight-line running is not on the list and starts on the same week eight to ten schedule.
22) Gradual Return-to-Jogging Program
Reintroduces running step by step in short sessions, not all at once. Start in weeks eight to ten, after meeting the entry conditions and with your care team’s approval. If the knee gives way, feels unstable or hurts while you are running, stop there and contact your care team; if swelling or a limp returns after running, go back to the previous week of your running programme.
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Before you start: Returning to running is gradual and starts in weeks eight to ten, provided range of motion has normalised and pain and swelling are minimal; reaching the date alone is not enough. Wear suitable shoes. Before you start, warm up by walking.
How to do it:
- After meeting all the entry conditions, start with 1 minute of light jogging and 1 minute of walking, following your physiotherapist’s plan; alternate the two until the combined time spent jogging and walking reaches 30 minutes.
- In every session watch your stride: short steps, a soft landing and no limp.
- Rather than increasing speed, first increase the share of jogging slightly within the same time.
- Check with your physiotherapist before running on a different surface.
- After each session check swelling and knee pain into the next day; if either has increased, take the next session back to the previous week.
Movement tips: For now, run straight without steep slopes. Sudden direction changes, rapid stops and contact sport are outside this exercise. Keep the pace easy enough to talk and breathe regularly. Do not put two running sessions on consecutive days. Steps should be symmetrical, controlled and without limping, and no swelling should appear the next day. Follow the cold-treatment instructions in the care section.
Amount, repetitions and progression: To start, do 2 to 3 sessions a week on nonconsecutive days. Start with short running bouts with walking in between; each week make the running share a little longer and the walking share shorter, until you can run continuously. Increase the duration before the speed. If swelling or a limp returns, or you have pain after running, go back to the previous week.
Stop immediately if: you develop pain while running, or the knee gives way or feels unstable.
Common mistakes: Increasing speed and distance at the same time, not following the session spacing in your physiotherapy plan, and ignoring next-day swelling.
Easier version: Go back to brisk walking, or continue the preparation stage: backward treadmill walking with your physiotherapist's teaching and supervision and the bike for endurance.
23) Backward Running
Running backwards trains step control in another direction. From week twelve, on a safe path, and after you have tolerated straight-line running for several sessions without pain or swelling. Stop if balance is unsafe, the knee gives way, or you develop pain.
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Before you start: Backward running practises step control in another direction. Start from week twelve and after tolerating straight running without pain, swelling or a limp. Wear suitable shoes and choose a flat, clear route; on a treadmill, do this only with the side rails and at low speed. Stand facing away from the route, trunk upright and knees slightly bent. In the reference rehabilitation protocol, backward running is placed in weeks twelve to sixteen.
How to do it:
- Start by walking backwards with short steps until you get the feel of the route and the rhythm.
- Land on the ball of the foot first and transfer the weight onto that foot slowly.
- Do not lock your knees; allow them to bend and straighten as you step.
- Once your steps feel confident, build the speed gradually up to a light jog.
- To finish, reduce the speed gradually and return to normal walking.
Movement tips: Follow a short, straight route with short, controlled steps; do not turn quickly or change direction. Breathe freely and keep the pace easy enough to talk. Walk between sets until breathing and calves settle. Keep the trunk upright and knees aligned with the feet.
Amount, repetitions and progression: A few runs along a short marked stretch, never on consecutive days. Build the length of the stretch first and the speed afterwards. If pain or swelling increases the next day, go back to the previous distance. Each time you add distance or speed, keep full control of every step.
Stop immediately if: you are unsure of your balance or lose it, the knee gives way, the knee or calf hurts, or you are unsure the path behind you is safe.
Common mistakes: Repeatedly looking back and twisting the trunk, long steps, locking the knees, and training on a busy or uneven path.
Easier version: Only walk backwards, with short steps, preferably on a treadmill with a hand on the rail.
24) Progressive Jumping Drills (Plyometric Drills)
This exercise brings you back to jumping and landing step by step; landing quality matters more than jump height. Practise only under a physiotherapist’s supervision. Stop if the knee falls inward on landing, the landing is loud, or the knee hurts or gives way.
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Before you start: The aim of progressive jumps is to practise controlled landing. In this version it does not start before the end of month four, and then only when prescribed and directly supervised by your physiotherapist, after tolerating the running programme and meeting strength and control criteria. Wear sports shoes and stand on a flat, slightly resilient surface in a clear area, feet hip-width apart, knees slightly bent and trunk upright.
How to do it:
- Begin with very small two-footed jumps on the spot.
- As you land on both feet, keep your knees and hips slightly bent to cushion the landing gently.
- Keep the knees over the line of the toes on landing and do not let them fall inward.
- Settle the landing quality over several sessions before increasing the height.
- Single-leg jumps are added only with permission and after two-footed landings are fully controlled.
Movement tips: Keep jump height and number low. Do not turn in the air, jump down from a height or land on one leg without permission. Move rhythmically and breathe freely. Land softly and quietly, knees aligned with the toes and balance regained immediately. Rest fully between sets so fatigue does not reduce landing quality. Cold-treatment instructions are in the care section.
Amount, repetitions and progression: In short bouts, never on consecutive days; end each bout while the landings are still controlled and quiet. Start with two-footed jumps on the spot; more height or a single-leg jump is added after several sessions of controlled landing. If the knee swells after exercise, reduce the number of jumps.
Stop immediately if: the knee falls inward on landing, landing becomes heavy and loud, or the knee hurts or gives way.
Common mistakes: Starting with too much height, landing with straight and locked knees, continuing when tired, and adding single-leg jumps too early.
Easier version: Go back to very small jumps on the spot, or even fast heel raises, until landing control settles.
25) Change-of-Direction and Sports Movement Programme (Cutting and Agility Program)
Trains changes of direction with lateral movement, crossover side steps and figure-of-eight paths. In this version this stage runs a few weeks after the end of month four, after the jump drills, because twisting the knee earlier is too soon for a repaired meniscus. Stop if the knee feels unstable or gives way, you have pain, or movement quality clearly declines.
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Before you start: This programme prepares the knee for planned changes of direction. Start this programme a few weeks after you start the jump drills; the jump drills themselves do not start before the end of month four. To start it, you must tolerate running and the jump drills, and your front-thigh muscle strength must be at least 90 per cent of the sound leg. Use a flat, non-slip sports surface, sport-appropriate shoes and route markers. Warm up with walking, light jogging and stretching, then stand at the start of the route.
How to do it:
- Begin with lateral movement in a straight line at low speed.
- Add carioca (crossover side steps) slowly with a steady trunk.
- Run the figure-of-eight path with wide curves at low speed.
- Gradually tighten the curves and increase the speed; change only one of the two in each session, not both together.
- Add drills specific to your own sport last, once you can do the three patterns above without next-day swelling.
Movement tips: Practise only predetermined routes while breathing freely. Contact, reacting to an opponent and actual match situations belong to a later stage with separate permission. Direction changes should be smooth, the knee aligned with the foot and balance maintained after each change. Rest long enough between sets to prevent fatigue reducing movement quality.
Amount, repetitions and progression: A few repetitions of each pattern per session, never on consecutive days. Start with changes of direction at slow speed and a wide angle, and increase one thing at a time: speed first, then the sharpness of the angle. A full return to pivoting sport does not happen before six months and also requires passing the strength and movement-control criteria; in young athletes, returning before nine months has been associated with a higher risk of a second injury. If swelling returns after a session, go back one stage.
Stop immediately if: the knee feels unstable or gives way, you develop pain, or movement quality clearly declines.
Common mistakes: Increasing speed and tightening the curves at the same time, changing direction on a planted foot with a straight knee, starting without a warm-up, and going straight to competition without this stage.
Easier version: Go back to lower speed and wider curves, or practise only straight lateral movement.
🚗 Driving, work, prayer and daily activities
For each daily activity below you will find the usual timing and the condition you need to meet. The figures come from published research and from the clinic’s own programme, and you should read them together: reaching the date without meeting the condition is not enough.
- Driving: Drive only when you can react quickly and make an emergency stop safely, when no brace or crutch interferes with controlling the car, and when you are not taking an opioid painkiller, alprazolam, gabapentin or another sedating medicine. In Dr Emad’s programme, driving starts about 6 weeks after surgery, whether the right or the left knee was operated on and whether the car is manual or automatic. Before your first drive, practise an emergency brake a few times with the engine off.
- Work: in Dr Emad’s programme, desk work from week two to four, provided you can travel safely and keep the leg elevated during the day; and standing or stair-based work from month two to three. Separately, in a study pooling the published work on returning to work, most patients were back within 90 days.
- Prayer: because your meniscus was repaired, ordinary kneeling starts after the end of month four, on a soft mat and once you can bend down and get up without strain or loss of balance. Until then pray seated or on a chair; follow your own religious authority’s guidance in choosing the alternative.
- Sexual activity: after about two to three weeks, once the wound has closed and pain is controlled. Choose a position in which the operated knee is not deeply bent and does not take your body weight; you may take the brace off for this and refasten it afterwards. Stop if the knee hurts or feels unstable.
- Long travel: For long flights or road trips of more than a few hours, your care team will assess your blood clot risk and mobility to decide whether you need to postpone the trip. Everyone needs this assessment, regardless of the type of medicine they take or whether they have completed the course. If you must travel, get up and walk regularly, or at least pump the ankle up and down several times, and drink enough water. If you have been prescribed an anticoagulant (a medicine such as apixaban that helps prevent blood clots), keep taking it exactly as prescribed.
❓ Frequently asked questions
1) When are the sutures removed?
Under Dr Emad’s plan, sutures that require removal are taken out 2 to 3 weeks after surgery. Do not remove sutures or wound adhesive yourself; they are taken out at your clinic appointment.
2) When can I shower?
You can take a short shower from 48 hours after surgery, provided the wound is dry and the waterproof cover is intact.
3) When will full flexion return?
The usual goals are: full straightening and at least 45 degrees of bend in week one, 90 degrees by the end of week two, 120 degrees by the end of week four, and full bend matching your other knee between weeks four and eight. Here, this means gently bending the knee while sitting or lying down, without putting your body weight on the bent knee; this goal does not allow deep squatting or kneeling before the end of month four. Forcing the knee to reach these angles sooner is harmful, especially if the meniscus was repaired.
4) Is clicking dangerous?
Painless clicking without swelling is common in the first months and is not dangerous; it usually settles as the muscle gets stronger. But if your knee locks (gets stuck and no longer straightens as it did before), gives way, or its clicking is accompanied by sharp pain or new or increasing swelling, stop the activity that causes the symptom. Contact your care team or a medical service now for assessment that same day, and do not wait for your next appointment.
5) Can I run in month three?
Light straight-line jogging starts in weeks eight to ten, not on reaching month three. Before you start, knee range of motion must have returned to normal, and pain and swelling must be minimal. Your care team must have assessed your strength, movement control and how you walk, and approved you to start jogging. You must also follow the restrictions specific to your meniscal repair. Controlled change-of-direction training, such as a figure-of-eight path with wide curves at low speed, is part of rehabilitation and starts at the time and under the conditions given in the “Change-of-Direction and Sports Movement Programme” card. A full return to pivoting sport does not happen before six months and also requires passing the strength and movement-control criteria.
6) What if my meniscus was repaired?
It depends on the type of tear. For a stable repaired vertical tear, weight-bearing and range of motion are not restricted. For complex, radial, root or horizontal tears, the 2024 international consensus recommends restrictions on weight-bearing and knee bending, but the restrictions and how long they last are not the same for every repair; follow your surgeon’s individual plan. In both cases deep squatting, jumping and twisting movements of the knee are left out for at least four months. Ask at your visit which type of tear you had. In Dr Emad’s programme, crutches are needed for 5 to 6 weeks after a meniscal repair.
7) How long is knee swelling expected?
Knee swelling may take several months to settle after surgery. One study assessed 160 patients after their first ACL reconstruction using a tendon from the back of their own thigh. One year later, MRI scans of the inside of the knee showed a moderate or large amount of fluid in 46 of them (28.8%). This imaging finding relates to that group; it does not mean that every visibly swollen knee is normal or predict how long your swelling will last. What matters is the trend, not the swelling itself: if today’s activity makes tomorrow clearly more swollen, reduce the amount. Sudden or progressive swelling, especially with calf pain or shortness of breath, requires immediate action as described in the warning-sign section.
8) When should I change the dressing?
Do not open it yourself. The dressing stays on until your first clinic visit, 10 to 14 days after surgery, and is changed there. Only replace it earlier if it is wet, dirty, loose or bloody, and call for an earlier appointment.
9) How long will I need crutches?
In Dr Emad’s programme, because your meniscus was also repaired, you need crutches for 5 to 6 weeks. But the date alone is not enough: you stop the crutches when you can tighten the muscle at the front of your thigh firmly, keep the knee straight while walking, and walk without a limp or increased pain or swelling. One crutch first, the second a few days later.
10) Must the brace stay on all the time?
No. The brace stays locked straight for walking and for sleeping, but you open it for range-of-motion exercises. At week four the post-operative brace is left off. If a complex meniscal tear was repaired, the brace stays on until the end of week six. For returning to sport, a separate sports brace is prescribed. Do not change the lock setting yourself.
11) When does physiotherapy start?
The simple exercises in this guide start on day one, and formal physiotherapy sessions begin from the second day after surgery. Your simple meniscal repair does not limit weight-bearing or knee bend, so the exercises of the first weeks are those of the reconstruction alone, except for what follows. The difference starts on day one with the crutches: in Dr Emad’s programme, with a meniscal repair, crutches are needed for 5 to 6 weeks, not 2 to 4 weeks as for the reconstruction alone. In this version the wall squat and mini squats also start from week four, to a depth of up to 30 degrees. Deep bending, jumping and twisting of the knee also wait until at least the end of month four.
12) When can I drive?
Only when you can perform an emergency stop promptly and without pain, no brace or crutch interferes with control, and you are not taking an opioid painkiller, alprazolam, gabapentin or another sedating medicine; if you are not sure whether yours is one of these, check the medicines section or ask your pharmacist. In Dr Emad’s programme this is about 6 weeks after surgery, for the right or left knee and for any type of car.
13) When can I return to work?
In Dr Emad’s programme, desk work from week two to four, provided you can travel safely and keep the leg elevated during the day; and standing or stair-based work from month two to three. Separately, in a study pooling the published work on returning to work, most patients were back at work within 90 days of surgery, and the mean with a hamstring graft was about 84 days. Heavy work, and work involving kneeling or repeated climbing, starts later and closer to return to sport.
14) When can I kneel or pray in the usual position?
Because your meniscus was repaired, kneeling comes after the end of month four, on a soft mat, and once you can bend down and get up without strain or loss of balance. Until then, pray seated or on a chair. Pain at the front of the knee, which is more common with a patellar tendon graft, may delay this further.
15) What should I do if the knee will not fully straighten?
Do not leave a pillow directly under the knee; put it under the calf and heel so the knee straightens under its own weight. Do the straightening exercises in this guide several times a day. Full straightening is the goal of the first week. If straightening is not improving week by week, or has got worse than the week before, call that same week rather than waiting for your next appointment. A knee that does not straighten is harder to treat later. Full knee straightening is the single most important goal of the first weeks.
16) When can I resume sexual activity?
After about two to three weeks, that is, once the wound has closed and pain is controlled. Choose a position in which the operated knee is not deeply bent and does not take your body weight; you may take the brace off for this and refasten it afterwards. Stop if the knee becomes painful or feels unstable.
17) Will I need a follow-up X-ray after surgery?
In Dr Emad’s programme, a routine follow-up X-ray is not needed. If an examination or a new symptom calls for one, it is requested at that visit.
✅ Summary and appointments
Recovery after ACL reconstruction progresses through regular wound care, swelling control and restoring movement and strength. Perform exercises with good form and within your plan; both knee readiness and the time needed for healing guide progression.
If you are still deciding about surgery or preparing for it, the guide to ACL reconstruction before surgery explains the injury, what may happen without surgery, preparation, surgery day, graft choices and decisions about the meniscus.
If you have a sign from the “Same-day contact with your care team” list in the warning-signs section, contact them that day. For questions about knee straightening, swelling or your exercise plan, call Dr Jalil Emad’s clinic on 09137825207, or book an appointment online. In an emergency, do not wait for the clinic to reply; follow the instructions in the warning signs section.
For more about this area of treatment, visit the related service page: Knee arthroscopy (surgery inside the joint using a camera).
This content is provided for general education only and does not replace an examination, advice from your treating clinician, your discharge sheet or your surgeon’s specific protocol. Timing, range of motion, weight-bearing and the amount of exercise vary with the procedure, any other treatment carried out during the same surgery and each person’s condition. Do not change medication, dressing care or your exercise plan without consulting your care team.
📚 Scientific references
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