Sports knee: rehabilitation guide
Last reviewed 5 August 2026 · Reviewed by Dr Matthew Broadhead, FRACS (Orth) · 26 minute read
This guide is for an ACL reconstruction WITH meniscal repair: an ACL graft plus stitches in the meniscus. Your operation record says which operation you had. If your ACL was reconstructed without a meniscal repair, you follow a different, faster programme: see the guide "ACL reconstruction" instead. The two programmes are different, and following the wrong one matters. This one protects a stitched meniscus that the other programme would overload. If you are not sure which applies to you, call the rooms before you start.
Why the extra caution? Only the outer quarter or so of the meniscus has a blood supply, so stitched meniscus heals slowly: three months and more. Early deep bending and twisting shear the repair. Protecting it now buys you a meniscus for life; a failed repair means another operation and a higher long-term risk of arthritis. The brace, the crutches and the 90-degree limit are not padding. They are the treatment.
Everything else about ACL rehabilitation still applies: full extension early, swelling control, quadriceps activation, and a nine-to-twelve-month road back to pivoting sport. Every timeframe in this guide is typical, not a rule, and Dr Broadhead’s instructions for you, especially the weight-bearing and range limits in your operation record: always override the general figures here. If you are reading this before surgery, prehabilitation still matters: a straight, quiet, strong knee going in predicts a better knee coming out.
Two things were fixed at one operation. First, the torn anterior cruciate ligament (ACL) was replaced with a graft, from the hamstrings, the patellar tendon (BTB) or the quadriceps tendon; your operation record says which. The graft is fixed strongly from day one and remodels into a living ligament over many months.
Second, the torn meniscus. One of the two C-shaped shock absorbers between the thigh and shin bones, was repaired with stitches rather than trimmed away. A repair is chosen when the tear can heal, because keeping the meniscus protects the joint surface for decades. But only the outer quarter or so of the meniscus has a blood supply, so the stitched tissue heals slowly, and for the first months it must be shielded from the deep bending and twisting that would shear the stitches apart.
Some repairs need more protection than others. Root repairs (where the meniscus anchors to bone) and radial repairs (tears across the full width) carry the highest load and are the most protected, if that is you, your operation record will set stricter weight-bearing and range limits than the typical figures in this guide. Your operation record wins every time.
Routine braces are not used after an isolated ACL reconstruction, but yours is not an isolated reconstruction. The hinged brace, the 0–90° limit and the protected weight bearing exist to shield the meniscal stitches while they heal. Wearing the brace loosely, unlocking it early or "just squatting once" undoes work that cannot be re-done without another operation.
Best practice is criteria-based progression. Time sets the earliest possible date for each step; objective criteria decide whether you actually move. Each phase in this guide lists both. With a meniscal repair, time carries extra weight in the early months, because the stitches heal on biology’s schedule, not on effort.
The first fortnight still has four jobs: full extension, minimal swelling, quadriceps activation without a lag, and a safe walking pattern with the crutches and brace. Full extension does not threaten the repair. It is allowed, expected and worked on from day one. It is deep bending under load that is off the menu.
Increasing swelling after a session means the load was too high. A knee that is bigger the next morning means you did too much yesterday. With a repair on board, respect the brake even more, swelling is the knee’s only way of telling you the load reached tissue that is trying to heal.
Returning to pivoting sport before nine months substantially increases ACL re-injury risk. Each additional month of delay up to nine months meaningfully reduces that risk, and passing a full discharge test battery reduces it further. The two together are far stronger than either alone. With a meniscal repair, the window is nine to twelve months.
Hamstring graft: avoid heavy resisted hamstring curls and end-range hamstring stretching for about 4–6 weeks; posterior thigh ache and a numb patch below the incision are common. Patellar tendon (BTB): expect more front-of-knee and kneeling discomfort; kneecap mobilisation matters more, and kneeling tolerance is a late milestone. Quadriceps tendon: a slower start to quadriceps activation, be patient with early strength numbers; front-of-knee tenderness settles. Your operation record says which you had.
Weight bearing
Protected weight bearing with crutches, in the hinged brace: exact limits set by your operation record
Unlike an isolated ACL reconstruction, you do not simply put full weight through the leg from day one. Load squeezes and shears the stitched meniscus, so weight bearing is protected, typically touch or partial weight with two crutches, in the brace, for the early weeks. Your operation record sets your exact limit; root and radial repairs are usually the most restricted.
This is the single biggest practical difference from the isolated pathway, and the reason the two guides must not be mixed. A friend who was off crutches at ten days after their ACL reconstruction had a different operation from you.
Weight bearing is progressed at your reviews as the repair heals, not by feel, and not by the calendar alone.
| Stage | Typical timing | Move on when |
|---|---|---|
| Two crutches, protected weight bearing, brace on | Weeks 0 to 4–6 | As set in your operation record: confirmed at the 2-week review |
| Weaning to full weight bearing | From the 4–6 week review | Cleared at review; brace range opened; quadriceps control returning |
| One crutch, then none | About weeks 6–8 | Walking without a limp; swelling not increasing with walking |
Only the outer quarter or so of the meniscus has a blood supply, so stitched meniscus heals slowly: three months and more. Early deep bending and twisting shear the repair. Protecting it now buys you a meniscus for life; a failed repair means another operation and a higher long-term risk of arthritis.
| Rule | Why | How to manage |
|---|---|---|
| Wear the hinged brace, set 0–90°, whenever you are up, for the first 4–6 weeks | Bending past 90 degrees rolls the thigh bone back over the repaired part of the meniscus and stresses the stitches. | Check the dial settings daily; do not change them yourself. The range is opened at your review, not at home. |
| Keep to your protected weight-bearing limit with two crutches for the first 4–6 weeks | Body weight compresses and shears the healing meniscus long before it can take the load. | Follow the limit in your operation record. If you have forgotten what it is, call the rooms rather than guessing. |
| No loaded deep bending: deep squats, lunges, kneeling back on your heels, for 3–4 months | Deep flexion under body weight puts the highest compressive and shear load on exactly the part of the meniscus that was stitched. | Squat-type strength work stays above 90 degrees until cleared. Use a raised chair, a shower stool and a long-handled reacher early on. |
| No twisting or pivoting on the planted foot for 3–4 months | Rotation grinds the tibia against the healing meniscus. It is the classic mechanism that tears a repair. | Turn by stepping around in small steps, not by swivelling. This also protects the ACL graft, which shares the same enemy. |
| Root and radial repairs: expect stricter limits than the figures above | These repairs carry the highest mechanical load and have the most to lose. They are the most protected of all. | Your operation record overrides this guide. When the record and the guide disagree, the record wins. |
| Period | Instruction |
|---|---|
| Weeks 0 to 4–6 | Worn whenever you are up on your feet and while doing your exercises, with the dials set to your prescribed range. It may come off for showering (seated) and for icing, once the wound allows. |
| At night | Follow your operation record: some repairs are braced at night in the early weeks and others are not. If the record does not say and you are unsure, call the rooms. |
| From the 4–6 week review | The range is opened and the brace is weaned as quadriceps control returns, on Dr Broadhead’s instruction, not by feel. |
| Period | Permitted range |
|---|---|
| Weeks 0 to 4–6 | 0–90°: full straightening allowed, bend limited to a right angle, set on the brace dials |
| From the 4–6 week review | Opened progressively as advised at review; unrestricted range only when cleared |
| Milestone | Earliest (weeks) | Typical | Latest |
|---|---|---|---|
| Walking with crutches, brace on, protected weight bearing | 0 | 0 | 1 |
| Wound review | 2 | 2 | 3 |
| Desk work (brace on, leg elevated) | 1 | 2 | 4 |
| Clinical review with X-ray: brace range opened, weight bearing progressed | 6 | 7 | 8 |
| Off crutches | 6 | 7 | 9 |
| Brace off | 6 | 7 | 9 |
| Stationary cycling | 6 | 8 | 10 |
| Driving (criteria met, discussed with us) | 7 | 9 | 12 |
| Physical work | 12 | 14 | 20 |
| Loaded deep bending and twisting cleared (at review) | 12 | 14 | 17 |
| Three-month review | 12 | 13 | 14 |
| Running (if criteria met) | 16 | 18 | 24 |
| Six-month review | 26 | 26 | 28 |
| Change-of-direction training | 26 | 30 | 36 |
| Nine-month review and return-to-sport testing | 39 | 39 | 42 |
| Return to pivoting sport (testing passed) | 39 | 48 | 56 |
| Twelve-month review | 52 | 52 | 56 |
You move to the next phase by meeting its exit criteria, not by the calendar. The week numbers are typical, nothing more.
Shield the repair: brace on, range 0–90°, protected weight bearing, while doing the same four early jobs as every ACL knee: extension, swelling, quadriceps, safe walking.
Ready for the next phase when…
Consolidate extension and quadriceps control inside the 0–90° window, keep the repair quiet, and prepare for the review where the limits come off.
Ready for the next phase when…
Out of the brace and off the crutches: regain the full bend gradually, walk normally, and build strength, still without loaded deep bending or twisting.
Ready for the next phase when…
Return to running, about a month later than the isolated pathway, then build volume, heavier strength and pre-planned agility.
Ready for the next phase when…
Cutting, pivoting and reactive agility, then non-contact and finally contact team training: the same territory as every ACL knee, entered a little later.
Ready for the next phase when…
Full training, then match play, with a repaired meniscus, the return window is nine to twelve months, and the prevention habits are permanent.
Ready for the next phase when…
Little and often beats one heroic session. Each exercise lists what you should feel, sharp pain that lingers afterwards means ease off and, if it persists, call.
Keep blood moving in the calf: your main clot-prevention exercise, doubly important while weight bearing is restricted.
10 firm pumps, every waking hour, for the first 2 weeks
Feel: You should feel the calf muscles working. The brace does not get in the way of this one, no excuses.
Switch the thigh muscle back on: swelling turns it off, and everything else depends on it.
10 holds of 5 seconds, 3–4 times daily
Feel: You should feel this in the front of the thigh. A quadriceps tendon graft makes this harder at first, persist; a slow start here is expected.
Harder: Your physiotherapist may add muscle stimulation (NMES) over the quadriceps if activation is slow.
Keep the bend easy within the permitted range, without stressing the meniscal repair.
10 slow slides to 90 degrees, 3–4 times daily
Feel: 90 degrees is a right angle: shin vertical when lying down. If in doubt, stop short. The limit applies even though the knee could bend further. That is the point.
Quadriceps strength with the knee locked straight. The milestone is lifting without a lag.
10 lifts, hold 3 seconds, 3 times daily
Feel: If the knee sags as you lift (a “lag”), keep working the static quads. The lag going is the sign of progress.
Full straightening: fully allowed, fully expected, and still the highest-priority exercise in this guide.
5–10 minutes, 2–3 times daily
Feel: A firm stretch behind the knee is exactly right. The meniscal repair does not restrict straightening, do not let the brace make the knee lazy about extension.
Gravity-assisted full extension: the partner exercise to the heel prop.
3–5 minutes, 2–3 times daily
Feel: A firm stretch behind the knee is the goal. If you had a hamstring graft and feel a pull in the back of the thigh rather than the knee, shorten the time and build up.
Keep the kneecap gliding freely so the bend and the scar do not tether: extra important after a patellar tendon (BTB) graft.
1–2 minutes in each direction, twice daily, once the dressing allows
Feel: It should feel odd, not painful.
A safe, consistent walking pattern inside your weight-bearing limit. The pattern you will keep for 4–6 weeks, so make it a good one.
Short walks every waking hour, within your weight-bearing limit
Feel: Slow and tidy beats fast and ragged. If you cannot remember your weight-bearing limit, call the rooms, do not guess upward.
Strengthen the last few degrees of straightening, safe, repair-friendly quadriceps work in the range that matters most.
2–3 sets of 10, hold 3 seconds, once or twice daily
Feel: All the movement happens below the knee, well inside the 0–90° window. Push through to completely straight every repetition.
Keep the bend easy and comfortable up to the brace limit.
10 bends, hold 5 seconds, 2–3 times daily
Feel: Foot directly under the knee is roughly 90 degrees; behind that line is past the limit. After the 4–6 week review, this exercise progresses past 90, not before.
Calf strength: one of the few standing strength exercises fully open to you early, within your weight-bearing limit.
2–3 sets of 10, once or twice daily, within your weight-bearing limit
Feel: Once cleared for full weight bearing, share the load evenly, then progress to single-leg raises.
Harder: Single-leg raises on the operated side after clearance at the 4–6 week review.
The knee’s position sense (proprioception), started once weight bearing is cleared, then progressed steadily.
Build to 3 holds of 30 seconds each leg, daily, once cleared for full weight bearing
Feel: Quiet foot, soft knee, tall posture. Balance work, not twisting work. The foot stays planted and the body stays square.
Soften and desensitise the scars, including the graft donor site: once fully healed.
2–3 minutes, twice daily, from about 3 weeks once healed and dry
Feel: Firm enough to blanch the skin slightly; it should not be painful. A numb patch near the incision is common: massage the edges of it; it usually shrinks with time.
Real-world double-leg strength, reintroduced once the brace and crutches are gone.
2–3 sets of 8–10, once or twice daily, from Phase 3
Feel: Start from a higher chair than usual. A low chair takes the knee deeper than the repair wants this early. Share the load evenly, no cheating onto the good leg.
Harder: Lower the chair height gradually as the deep-bending restriction lifts at 3–4 months.
Thigh and hip strength through a small, repair-safe range.
2–3 sets of 10 to about 45 degrees, once or twice daily, from Phase 3
Feel: Shallow is the point: deep loaded bending waits until 3–4 months and clearance. Knees track over the toes, no diving inward.
Single-leg strength for stairs, slopes and: eventually: running.
2–3 sets of 8 each leg, once daily, from Phase 3
Feel: A low step keeps the knee bend modest: right for a healing repair. Push through the whole foot; knee over the toes.
Harder: Raise the step height only as the deep-bending restriction lifts.
The controlled lowering strength that landing, decelerating and cutting are built on.
2–3 sets of 8 each leg, alternate days, from later in Phase 3
Feel: Slow and controlled beats deep; keep the pelvis level and the knee over the toes.
Harder: Raise the step, slow the lowering, remove hand support.
Rebuild hamstring strength: the muscle group that actively protects the ACL graft.
2–3 sets of 10, once daily, from 6 weeks
Feel: If you had a hamstring graft, this is deliberately delayed until about 6 weeks, donor-site ache when you start is normal and settles.
Harder: Add an ankle weight, then progress to gym-based hamstring work with your physiotherapist.
Range, circulation and endurance, reintroduced once the brace limit is lifted and the bend allows a full revolution.
10–20 minutes, most days, from about 6–8 weeks once cleared and the bend allows
Feel: Cycling waits until after the 4–6 week review on this pathway. A full pedal stroke needs more bend than the brace allows.
The measuring stick for return to sport: performed and scored with your physiotherapist, not alone.
Testing sessions with your physiotherapist from Phase 4 onward, not a daily exercise
Feel: The target is at least 90% of the other leg on every test. How you land is scored as well as how far you hop. A long, ugly hop does not pass.
Follow your operation record on whether the brace is worn at night in the early weeks: practice varies with the repair. If the record does not say and you are unsure, call the rooms.
Never sleep with a pillow under the knee. If you want support, place a pillow under the whole lower leg from calf to heel, so the knee rests straight.
On your back with the leg elevated is usually the most comfortable position for the first weeks, and it helps the morning swelling. Side sleeping works with a pillow between the knees once comfortable.
Expect real pain for the first week or two, needing regular pain relief. A two-part operation (graft plus repair) is often sorer early on than an isolated reconstruction. Take medication as prescribed and ahead of exercise sessions rather than chasing pain afterwards.
Wean the strongest medications first as things settle.
Donor-site pain is its own story: hamstring grafts commonly ache in the back of the thigh for some weeks, patellar tendon (BTB) grafts at the front of the knee, especially with kneeling, and quadriceps tendon grafts above the kneecap. All of it settles; none of it means something is wrong with the graft.
Joint-line ache on the side of the repair with the first deeper bends and the first weeks of walking is common. Sharp joint-line pain with a click or catch, or a knee that locks, is different, call the rooms.
You may drive when all of the following are true:
What the research actually measures is braking reaction time on a simulator. Those studies show braking performance returns to its pre-operative level at about 2 weeks after a right hip replacement and about 4 weeks after a right knee replacement, with movement time back to normal by 6 weeks. After knee arthroscopy the simulator evidence is more conservative than common practice: in the one study that measured it directly, braking was still slower one week after surgery than before it, and had recovered by four weeks, and a 2021 review of eight studies put the average return at about six weeks. Most people having a simple arthroscopy are driving well before that, which is why the criteria above matter more than the date. But these are averages, in one study, about one in three right-hip patients still could not meet an emergency-stop benchmark at six weeks. Treat the timeframes in this guide as targets for discussion with us, not as permissions.
No published study has compared automatic and manual cars. The logical point is simply that a manual needs the left leg for the clutch, so left-sided surgery is the relevant caution in a manual. Advice about driving earlier with a left-leg operation in an automatic is clinical judgement, not trial evidence.
In Australia, your treating doctor’s advice governs: under the Austroads "Assessing Fitness to Drive" standards, temporary post-operative impairment is a matter of clinical judgement, and commercial drivers are held to a higher standard. Driving while impaired may invalidate your insurance, check your insurer’s position. Do not drive for at least 24 hours after any general anaesthetic or sedation.
| Activity | Typical | When it’s right | Notes |
|---|---|---|---|
| Walking for exercise | From about 6–8 weeks (unaided) | Cleared for full weight bearing; no limp | Before that, walking is crutch-and-brace walking within your limit |
| Desk work | About 2 weeks | Comfortable sitting with the brace on and the leg elevated; travel sorted | You cannot drive yourself yet: plan transport |
| Swimming (straight-line, no breaststroke kick) | After the brace is off, about 6–8 weeks | Wound healed; cleared at review | Flutter kick only; breaststroke kick loads the repair in exactly the wrong way. It waits until cleared |
| Stationary cycling | About 6–8 weeks | Brace limit lifted; enough bend for a full revolution | Saddle high at first |
| Driving | After the brace and crutches are gone: later than the isolated pathway | All the driving criteria below, discussed with us | A brace that limits knee movement rules out driving on its own |
| Physical work | Usually 3 months or more | Strength and endurance for the actual duties; squatting and twisting duties wait for the 3–4 month clearance | Modified duties in between where available: raise it at the 2-week review |
| Loaded deep bending and twisting (deep squats, lunges, pivoting drills) | Cleared from 3–4 months | Cleared at review: root and radial repairs may be later | The single most important restriction in this guide |
| Running (straight line) | From about 4 months: if criteria are met | Pain ≤2/10, no effusion, full range, quadriceps symmetry ≥70–80%, good single-leg squat, pain-free hopping | About a month later than the isolated pathway |
| Change of direction and sport-specific training | Months 6–9 | Strength and hop symmetry approaching 90% | Pre-planned first, reactive later; non-contact before contact |
| Pivoting sport (netball, football, soccer, basketball, skiing) | 9–12 months | Full return-to-sport test battery passed: strength ≥90%, hop battery ≥90%, movement quality under fatigue, psychological readiness | Time plus testing together protect the graft and the repair far better than either alone |
| Kneeling and squatting to the floor | From 3–4 months, built gradually | Deep-bending clearance given | Later and more gradually after a BTB graft, kneeling tolerance is a late milestone |
You will often hear "no flying for six weeks" after joint replacement. Be aware that this is a convention, not a proven rule: a 2025 review found limited data and no demonstrated difference in clot risk between people who did and did not fly after hip or knee replacement: mostly within the first week.
The six-week convention reflects practical realities rather than trial evidence: managing airports and cramped seating, being past the highest-risk clot window while still on prevention, the higher baseline clot risk of long-haul flights over four hours, and individual airline and travel-insurance rules, check both, as some airlines impose their own restrictions.
If you need to travel long-haul in the first six weeks, talk to the rooms first so clot prevention, an aisle seat, stockings and on-board movement can be planned.
None of these should be watched overnight to see how they go. Early treatment of a problem is simple; late treatment is not.
EMERGENCY: 000Emergency department / call 000
GP TODAYSee your GP today
CALL THE ROOMSCall the rooms: same day
For joint replacement patients, a wound problem is never something to "wait and see". Early treatment of an infected joint replacement is vastly more successful than late treatment, call the rooms the same day.
This guide is for an ACL reconstruction with a meniscal repair: stitches in the meniscus as well as a new ACL graft. Your operation record says which operation you had. If your ACL was reconstructed without a meniscal repair, follow the guide "ACL reconstruction" instead: it has no brace, no 90-degree limit and a faster start. The two programmes are genuinely different. If you are unsure which applies, call the rooms before starting.
Because bending deeply rolls the thigh bone back over exactly the part of the meniscus that was stitched, and shears the repair. Only the outer quarter or so of the meniscus has a blood supply, so the stitches hold slowly-healing tissue for three months and more. The 0–90° limit protects it through the most fragile weeks. Protecting it now buys you a meniscus for life; a failed repair means another operation and a higher long-term risk of arthritis.
Routine bracing after an isolated ACL reconstruction does not improve laxity, range, pain, graft survival or function, so those patients go without. Braces are used where the meniscus was repaired. That is you, and where other ligaments were involved or quadriceps control is poor. Your hinged brace holds the knee to 0–90° for the first 4–6 weeks to shield the stitches. It is not a precaution; it is part of the operation working.
Less than an isolated ACL patient, weight bearing is protected, with two crutches and the brace on, typically for the first 4–6 weeks. Load squeezes and shears the healing meniscus. Your exact limit is in your operation record, and root and radial repairs are usually the most restricted. If you cannot remember your limit, call the rooms rather than guessing upward. Weight bearing is progressed at your reviews, not by feel.
Typically 4–6 weeks: much longer than the one to two weeks after an isolated ACL reconstruction, because the crutches are protecting the meniscal repair, not just helping your balance. They start to go after the 4–6 week review, once your weight bearing is progressed and the brace range is opened, and they are fully gone when you can walk without a limp, usually around weeks 6–8.
Later than the isolated pathway. A brace that limits knee movement rules out driving by itself, and so do crutches, so driving waits until both are gone, typically some weeks after the 4–6 week review. Then the usual criteria apply: off strong painkillers, comfortable in the seat, and able to perform an emergency stop at full force without hesitation, practised in a stationary car first. Confirm your timing with us at review.
Desk work typically around two weeks, with the brace on, the leg elevated under the desk and transport organised. You cannot drive yourself yet. Physical work usually takes three months or more, because squatting, kneeling and twisting duties wait for the 3–4 month deep-bending clearance. Raise your job’s actual demands at the two-week review so modified duties can be planned early.
From about four months, roughly a month later than after an isolated ACL reconstruction, to give the meniscal repair its healing time. The criteria still rule the date: pain no more than 2 out of 10, no fluid in the knee, full range of movement, quadriceps strength at least 70–80% of the other leg, a good single-leg squat, and pain-free double- then single-leg hopping. The date does not open the gate.
Nine to twelve months, and only after passing formal return-to-sport testing: strength and hop symmetry at 90% or better, sound movement under fatigue, and psychological readiness. Returning to pivoting sport before nine months substantially increases re-injury risk, and each extra month up to nine lowers it; with a repaired meniscus the window sits at the later end. Netball, football, soccer and basketball are exactly the sports this rule exists for.
A root repair re-anchors the meniscus where it attaches to bone; a radial repair stitches a tear running across the meniscus’s full width. Both interrupt the hoop of tissue that spreads your body weight, so the stitches carry the highest loads of any repair, and have the most to lose. If your operation record names one of these, expect stricter weight-bearing and range limits than the typical figures here. The record overrides the guide, every time.
Usually a return of joint-line pain, clicking, catching or locking, sometimes after a bend or twist the knee was not ready for. A failed repair generally means another operation, often removal of the torn part, which raises the long-term risk of arthritis in that part of the knee. That is what the brace, the crutches and the 3–4 months of restrictions are buying you: a meniscus for life. Call the rooms if those symptoms appear at any stage.
Showering: the brace can come off once the wound allows, sit on a shower stool, keep the knee within its range, and put the brace back on before you walk anywhere. Sleeping: practice varies with the repair, so follow your operation record; some repairs are braced at night in the early weeks and others are not. If the record does not say and you are unsure, call the rooms rather than deciding at midnight.
Loaded deep bending and twisting: deep squats, lunges, kneeling back on your heels, pivoting on the planted foot, waits 3–4 months, until the repair is cleared at review. It is the single most important restriction in this guide. After clearance it comes back gradually, not all at once, and later again after a patellar tendon (BTB) graft, where kneeling tolerance is a late milestone in its own right.
Structured neuromuscular warm-up programmes roughly halve the risk of ACL injury, with the largest effect in female athletes. Ready-made versions exist for the sports that matter here: Prep-to-Play for AFL and AFLW, the Netball Australia KNEE Program, and FIFA 11+ for football. The dose is simple: twenty minutes, three times a week, forever. Among returning athletes under 25, roughly one in four re-injures an ACL, with the other knee at least as vulnerable as the graft. In those operated under 20, graft rupture alone reached 18% by five years. The warm-up is permanent.
| Claim | Source |
|---|---|
| Only the peripheral 10 to 25% of the meniscus is vascular, so repaired meniscus heals slowly | Arnoczky & Warren, Am J Sports Med 1982, microvasculature of the human meniscus (PMID 7081532) |
| Meniscal repair preserves function compared with meniscectomy but carries a higher reoperation rate; failed repair usually means resection | Paxton, Stock & Brophy, Arthroscopy 2011, meniscal repair versus partial meniscectomy systematic review (PMID 21820843) |
| Meniscal loss raises the long-term risk of knee osteoarthritis: the rationale for repairing and protecting the meniscus | Papalia et al., Br Med Bull 2011, meniscectomy as a risk factor for knee osteoarthritis, systematic review (PMID 21247936) |
| Root repairs are protected with restricted weight bearing and range because root tears defunction the meniscus (equivalent to meniscectomy if untreated) | LaPrade et al., Am J Sports Med 2017, posterior meniscal root repair outcomes (PMID 27919916) |
| Restricted rehabilitation (limited range and weight bearing) is standard for complex, root and radial repairs; freer rehabilitation may be acceptable only for simple peripheral vertical tears: evidence limited | O'Donnell et al., Am J Sports Med 2017, systematic review of rehabilitation protocols after isolated meniscal repair (PMID 28256906) |
| Return to pivoting sport before 9 months increases ACL re-injury; each month of delay up to 9 months reduces it, and passing discharge criteria reduces it further | Grindem et al., Br J Sports Med 2016, Delaware-Oslo cohort (PMID 27162233) |
| Roughly 1 in 4 athletes under 25 who return to sport sustain a further ACL injury to either knee | Wiggins et al., Am J Sports Med 2016, systematic review and meta-analysis (PMID 26772611) |
| In patients reconstructed under 20, graft rupture alone was 18% at a mean 5 years, highest at 28.3% in males under 18; 47% of ruptures occurred in the first postoperative year | Webster & Feller, Am J Sports Med 2016 (PMID 27390346) |
| The other knee is at least as vulnerable as the graft: contralateral injury 8% against ipsilateral 7% | Wiggins et al., Am J Sports Med 2016, systematic review and meta-analysis (PMID 26772611) |
| Routine bracing does not improve outcomes after isolated ACL reconstruction, bracing here is for the meniscal repair, not the graft | Wright & Fetzer, Clin Orthop Relat Res 2007, systematic review of bracing after ACL reconstruction (PMID 17279043) |
| Criteria-based (not purely time-based) progression is best practice after ACL reconstruction | van Melick et al., Br J Sports Med 2016, evidence-based clinical practice update (PMID 27539507) |
| Athletes not meeting discharge criteria before return had about four times the graft rupture rate | Kyritsis et al., Br J Sports Med 2016, discharge criteria and graft rupture risk (PMID 27215935) |
| ACL-RSI scale measures psychological readiness; fear of re-injury is the most common reason athletes do not return | Webster, Feller & Lambros, Phys Ther Sport 2008, ACL-RSI development (PMID 19083699); Ardern et al., Br J Sports Med 2014, psychological readiness (PMID 25293342) |
| Structured neuromuscular warm-up programmes roughly halve ACL injury risk, with the largest effect in female athletes | Webster & Hewett, J Orthop Res 2018, meta-analysis of meta-analyses of ACL injury-reduction programmes (PMID 29737024) |
| FIFA 11+ structured warm-up reduces lower-limb injuries in football | Thorborg et al., Br J Sports Med 2017, FIFA 11 and 11+ systematic review and meta-analysis (PMID 28087568) |
This guide is general information for patients of Dr Matthew Broadhead (Harbour Orthopaedics & Sports Medicine) and is not a substitute for the specific advice given to you by Dr Broadhead, your physiotherapist or your hospital team.
Surgical findings vary, and your protocol may differ from what is written here: your operation record and your surgeon’s instructions always take precedence.
If in doubt, call the rooms on (02) 9052 1883. In an emergency, call 000.
Last reviewed: 2026-08-05 by Dr Matthew Broadhead, FRACS (Orth).
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