About Your Graft: This Affects Your Timeline
Patella Tendon Graft (Bone-Patellar-Bone)
Strongest graft. Early weight bearing. Full sports clearance typically at 9–12 months. Kneeling may be uncomfortable for months.
Hamstring Tendon Graft
Good strength, smaller scar. Hamstring strengthening delayed to Week 12. Return to sport similar to patella graft.
Quadriceps Tendon Graft
Strong graft with good outcomes. Follow surgeon's specific instructions for quad recovery in early phase.
Total rehabilitation: 9–12 months to full sport. Each phase requires clinical criteria to be met before progressing.
Phase 1
Immediate Post-op: Protect the Graft
Week 0 – Week 2🎯 Goals
- Control swelling and pain
- Achieve full knee straightening (0°)
- Begin getting the thigh muscle working again
- Walk safely with crutches
- Understand graft protection rules
⚠️ Precautions
- Wear knee brace locked straight when walking (until quad control achieved)
- Walk with crutches: weight as tolerated (allograft/hamstring: partial weight only for 6 weeks)
- No pivoting or twisting on operated leg
- Do not place pillow under knee: keep leg flat
- No straight leg raise if knee cannot fully straighten first
🧊
Ice, Elevation and Compression are your best friends this week:
Apply ice (wrapped in cloth) for 20 min every 2–3 hours · Keep leg elevated above heart level when resting · Use compression bandage · This reduces swelling which is critical for early recovery.
Exercises: Week 0–2
- Ankle pumps: 20 reps every hour (reduces blood clot risk)
- Quad sets: press knee flat into bed, hold 5 sec, 10 reps
- Straight leg raise: only once knee fully straightens without lag
- Heel slides: slide heel gently towards buttocks and back
- Kneecap mobilisation: gently push kneecap up/down and side to side
- Prone hang: lie face down, let leg hang off bed to stretch extension
- Calf raises: standing, holding chair
- Hip abduction: lie on side, raise top leg
- Heel prop: place heel on rolled towel, let gravity straighten knee
✅ Ready for Phase 2 When:
- Knee fully straight (0°): same as other leg
- Can do straight leg raise without the knee bending (no lag)
- Swelling significantly reduced
- Walking safely with crutches
Phase 2
Early Strengthening: Restore Normal Walking
Week 3 – Week 5🎯 Goals
- Walk normally without crutches
- Regain full knee bending (equal to other leg)
- Maintain full straightening
- Begin building thigh and hip strength
- Good balance on operated leg
Exercises
- Stationary cycling: begin with seat high, gentle pedalling
- Mini squats: 0–60° only, both legs, holding chair
- Step-ups: low step, hold railing
- Hamstring curls: standing or lying (not with hamstring graft yet)
- Bridges: lie on back, lift hips, hold 5 sec
- Clamshells: lie on side, open and close knees
- Single leg standing balance: hold chair, progress to unaided
- Hip strengthening: side leg raises, hip extension standing
✅ Ready for Phase 3 When:
- Swelling minimal (soft, not tense)
- Knee bending within 10° of the other leg
- Knee fully straight: equal to other leg
- Walking without limp and without crutches
Phase 3
Progressive Strengthening
Week 6 – Week 8🎯 Goals
- Full knee range of motion equal to other leg
- Normal walking on all surfaces
- Build leg strength systematically
- No swelling or pain after exercise
Exercises
- Squats: progress depth gradually
- Lateral lunges: side to side
- Romanian deadlift: single and double leg
- Lateral band walks: resistance band around ankles
- Single leg press: gym machine
- Step-ups and step-downs: higher step
- Hamstring strengthening: resisted curls (hamstring graft: begin at Week 12 only)
- Elliptical / pool jogging: from Week 8
- Single leg balance: progress to uneven surface
✅ Ready for Phase 4 When:
- No swelling or pain after exercise
- Normal gait on all surfaces including uneven ground
- Full knee range of motion equal to other leg
- Good balance and joint position sense
Phase 4
Power & Control: Begin Jump Training
Week 9 – Week 12🎯 Goals
- Begin controlled jumping and landing
- Build power in operated leg
- No pain or swelling with higher-load exercise
- Prepare for return-to-running
Exercises
- Double-leg jump and land: focus on soft landing, knees bent
- Box jumps: jump up onto box, step down
- Single-leg squat: aim for 10 reps to 60° depth with good form
- Shuttle jumps: double leg, then alternating
- Lumbopelvic exercises: planks, side planks, dead bugs
- Continue all Phase 3 strengthening
✅ Ready for Phase 5 When:
- 10 single-leg squats with good form to 60° depth: no wobbling
- Landing from jumps with good control: knees not collapsing inward
- No pain or swelling after training sessions
- Quad and hamstring strength ≥80% of the other leg (assessed by physio)
Phase 5
Return to Running & Sport-Specific Training
Month 3 – Month 5🎯 Goals
- Return to jogging and running pain-free
- Begin sport-specific movements in straight line
- Single-leg plyometrics with good control
- No episodes of knee giving way
Return to Running Program
- Week 1: Walk 5 min / Jog 1 min × 5 sets
- Week 2: Walk 3 min / Jog 3 min × 5 sets
- Week 3: Walk 2 min / Jog 4 min × 5 sets
- Week 4 onward: Continuous jogging, build duration
- Only progress if no pain or swelling during or after
- Run on flat soft surface initially (grass, track)
- Avoid road running until pain-free for 2 weeks
🏏 Sport-Specific (Straight Line)
- Forward running and backward running
- Figure-8 runs (wide arcs initially)
- Lateral shuffles and crossover steps
- Cricket: running between wickets, straight bowling run-up
- Badminton: straight forward/backward movement only
- No cutting, pivoting or sudden direction changes yet
✅ Ready for Phase 6 When:
- Running 20–30 min continuously without pain
- Quad and hamstring strength ≥90% of other leg
- Hop test ≥90% of other leg (physio assessment)
Phase 6
Return to Full Sport
Month 6 – Month 12🎯 Goals
- Multi-directional movement and cutting
- Full return to sport: non-contact then contact
- Strength symmetry ≥95% between legs
- Psychological confidence in the knee
🏏 Sport Progression
- Month 6–7: Cutting and pivoting drills, agility ladders, shuttle runs
- Month 7–8: Sport-specific contact-free practice
- Month 8–9: Non-contact team practice
- Month 9–12: Full practice → Full match play
- Cricket batting, bowling (spin): Month 6–7
- Cricket fast bowling, badminton: Month 9+
- Football/kabaddi: Month 9–12 with surgeon clearance
✅ Cleared for Full Sport When ALL of the following are met:
- Quad and hamstring strength ≥95% of other leg (physio testing)
- Hop test ≥95% of other leg
- Full pain-free range of motion
- No swelling after training
- Confident and psychologically ready: no fear of re-injury
- Surgeon clearance: mandatory
Activity Guide: When Can I Return to Normal Life?
| Activity | Allowed? | When | Notes |
|---|---|---|---|
| Walking (flat ground) | YES | Immediately | With crutches and brace initially; progress as quad control improves |
| Climbing stairs | CAUTION | Week 1–2 | Good leg up first, operated leg down first; hold railing |
| Driving | CAUTION | Week 4–6 | Only when off crutches and full quad control; right knee: confirm with surgeon |
| Two-wheeler | WAIT | Month 3+ | Risk of fall causing graft rupture; confirm with surgeon before resuming |
| Office / desk work | YES | Week 2–3 | Keep leg elevated when seated; take walking breaks every hour |
| Light housework | YES | Week 3–4 | Avoid prolonged standing or kneeling |
| Stationary cycling | YES | Week 3 | High seat, low resistance initially; excellent for recovery |
| Swimming | YES | Week 6–8 | After wound healed; flutter kick initially, avoid breaststroke kick early |
| Jogging / running | CAUTION | Month 3 | Only after passing Phase 4 criteria; use return-to-run program |
| Cricket (batting / running) | CAUTION | Month 6–7 | Straight-line running only first; cutting and full batting with surgeon clearance |
| Cricket fast bowling | WAIT | Month 9+ | High-demand pivoting activity; surgeon clearance required |
| Badminton / tennis | WAIT | Month 9+ | Rapid direction change sport: one of the highest re-injury risk activities |
| Football / kabaddi | WAIT | Month 9–12 | Contact sport; full clearance protocol must be completed |
| Squatting / kneeling | CAUTION | Month 2–3 | Avoid deep squatting early; kneeling may be uncomfortable with patella graft |
🚨 When to Call Dr. Satish Reddy
🔴 Call Immediately If:
- Sudden pop or giving way of knee during exercise
- Massive sudden swelling after a twist or fall
- High fever with wound redness or discharge
- Leg becomes cold, pale or numb
- Severe calf pain or chest pain / breathlessness
🟡 Call Clinic Within 24 Hours If:
- Swelling increases significantly after exercise
- Knee locks and won't straighten or bend
- Pain is not settling with rest and ice
- Wound is not healing or looks infected
- You feel the knee is less stable than before
📅 Follow-up Schedule
🗓 Clinic Follow-ups
- 2 weeks: Wound check, suture removal
- 6 weeks: ROM, strength, brace review
- 3 months: Strength testing, running clearance
- 6 months: Sport clearance assessment
- 12 months: Final sport clearance + X-ray
⚠️ Re-injury Prevention
- Always warm up before sport: 10 min minimum
- Continue hip and thigh strengthening lifelong
- Landing drills: knees bent, never stiff-legged
- Wear functional brace for sport if recommended
- Stop if knee swells after activity: report early
🏠 Daily Life Tips
- Avoid sitting with knee fully bent for long periods early on
- Keep leg elevated when watching TV or sleeping
- Non-slip mat in bathroom: fall prevention essential
- Do not rush: re-rupture risk highest at 6–12 months
- Take physio sessions seriously: they determine outcome