🔒 Why Root Repair Requires Extra Protection
- The meniscal root bears the highest compressive and hoop stresses in the knee: far more than the body or horn
- Failure of a root repair is equivalent to a total meniscectomy: aggressive early loading risks this
- Root repairs need strict NWB for 6 weeks: longer than standard meniscal repair
- Deep knee bending compresses the posterior compartment directly over the repair: avoid until cleared
- MRI at 3–6 months may be requested to confirm healing before sport clearance
📐 Knee Bending (ROM) Progression Schedule
| Week | Allowed Range of Motion | Notes |
|---|---|---|
| Week 0–4 | 0° – 90° only | No forced bending; avoid deep flexion at all times |
| Week 4–6 | 0° – 120° | Progress gently as comfortable |
| Week 6–10 | Full range as comfortable | Avoid forced deep flexion; no squatting past 90° until Week 10+ |
| Week 10+ | Full range including deep flexion | Only if pain-free and cleared by surgeon |
Phase 1
Strict Protection: Non-Weight-Bearing
Week 0 – Week 6⚠️ Weight Bearing: STRICT NWB
- Non-weight-bearing for 6 weeks: no weight through operated leg
- Both crutches at all times
- Brace locked in full extension when walking
- Toe-touch only if specifically authorised by Dr. Satish Reddy
- Do NOT progress weight bearing early: failure risk is high
🎯 Goals
- Protect the root repair completely
- Control swelling and pain
- Achieve full knee straightening (0°)
- Knee bending to 90° by Week 4
- Activate quad without stressing repair
Exercises: Week 0–6
- Ankle pumps: 20 reps every hour (DVT prevention)
- Quad sets: press knee flat, hold 5 sec, 10 reps
- Straight leg raise: only once knee fully straightens without lag
- Kneecap mobilisation: push up/down, side to side
- Prone hang / heel prop: gravity to restore extension
- Hip abduction and extension: side lying
- Heel slides: gentle, avoid active hamstring pull
- Upper body exercise: to maintain fitness
- Ice + elevation: 20 min every 2–3 hours; leg above heart
✅ Ready for Phase 2: After 6-Week Surgeon Review:
- Knee fully straight (0°) equal to other leg
- Knee bending to at least 90°
- Straight leg raise without lag
- Swelling well controlled
- Surgeon confirms adequate healing on clinical assessment
Phase 2
Progressive Weight Bearing & Mobility
Week 6 – Week 10🎯 Goals
- Week 6–8: partial weight bearing 25–50% with crutches
- Week 8–10: full weight bearing, wean off crutches
- Brace unlocked once quad control adequate
- Knee bending to 120° by Week 8
- Restore normal walking pattern
Exercises
- Stationary cycling: high seat, no resistance
- Mini squats: 0–45° only initially
- Calf raises, bridges, clamshells
- Standing hip strengthening: abduction, extension
- Single leg balance: holding chair initially
- Gait re-training: normal heel-to-toe pattern
- Patellar mobilisation: prevent stiffness
✅ Ready for Phase 3 When:
- Full weight bearing pain-free without crutches
- Knee bending ≥120°, fully straight equal to other leg
- Normal walking gait
- Minimal swelling
Phase 3
Progressive Strengthening
Week 10 – Week 16🎯 Goals
- Full ROM: equal to other leg
- Normal gait on all surfaces
- Build quad, hip and core strength
- 10 single-leg squats with good form
- No swelling after exercise
Exercises
- Squats: progress depth gradually to 70–80°
- Step-ups/step-downs: increasing height
- Lateral lunges, lateral band walks
- Single leg press (gym)
- Romanian deadlift: double then single leg
- Core strengthening: planks, side planks, dead bugs
- Hamstring strengthening: carefully; avoid high posterior load early
- Swimming flutter kick / pool jogging
- Cycling with progressive resistance
🏠 Daily Life
- Driving: from Week 10: off crutches, full quad control, off strong painkillers
- Two-wheeler: minimum 4 months
- Office/desk work: from Week 6–8 with regular movement breaks
- Light housework: from Week 8–10
✅ Ready for Phase 4 When:
- No swelling or pain after exercise
- 10 single-leg squats with good form to 60°
- Thigh strength ≥80% of other leg
Phase 4
Return to Running & Sport
Month 4 – Month 9+🎯 Return to Running (Month 4–5)
- 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+: Continuous jogging: build to 20–30 min
- Flat soft surface initially (grass/track)
- Only progress if no pain or swelling during or after
🏏 Sport Progression
- Month 5–6: Straight-line running, wide agility arcs
- Month 6–7: Cutting and pivoting drills
- Month 7–8: Non-contact sport-specific practice
- Month 8–9+: Full practice → match play with surgeon clearance
- Cricket batting/running: Month 6–7
- Fast bowling / badminton / pivoting sports: Month 9+
✅ Cleared for Full Sport When ALL Met:
- Quad and hamstring strength ≥95% of other leg
- Hop test ≥90% of other leg (physio assessment)
- Full pain-free ROM, no swelling after training
- Surgeon clearance: mandatory · MRI may be requested to confirm root healing
Activity Guide
| Activity | Allowed? | When | Notes |
|---|---|---|---|
| Walking (flat) | CRUTCHES | Immediately | Non-weight-bearing: both crutches, brace locked straight for 6 weeks |
| Stairs | CAUTION | Week 6+ | Only once partial weight bearing begins; hold railing |
| Driving | CAUTION | Week 10 | Off crutches, full quad control, off strong painkillers |
| Two-wheeler | WAIT | 4 months+ | Risk of fall; confirm with surgeon before resuming |
| Office/desk work | YES | Week 6–8 | Leg elevated when seated; regular movement breaks |
| Stationary cycling | YES | Week 6 | High seat, no resistance; excellent for recovery |
| Swimming | YES | Week 8–10 | After wound healed; flutter kick only initially |
| Jogging | WAIT | Month 4–5 | Only after Phase 3 criteria fully met |
| Cricket / badminton | WAIT | Month 6–9+ | Surgeon clearance required; batting earlier than bowling |
| Contact sports | WAIT | Month 9+ | Full clearance protocol must be completed |
| Deep squatting / kneeling | AVOID | Week 10+ | Avoid until cleared: directly compresses repair site |
| Indian toilet / floor sitting | AVOID | Month 3+ | Only once ROM adequate and surgeon confirms healing |
🚨 When to Contact Us
🔴 Come to Hospital Immediately
- Sudden locking or giving way of the knee
- Significant sudden swelling, especially after loading
- New severe posterior/inner knee pain with weight bearing
- High fever with wound redness or discharge
- Calf pain, chest pain, or breathlessness
🟡 Call Clinic Within 24 Hours
- Swelling increases after exercise that was previously fine
- Knee locks or won't fully straighten
- Pain not settling with rest and ice
- Wound not healing or looks infected
- Knee feels less stable than at last review
📅 Follow-up Schedule
🗓 Clinic Reviews
- 2 weeks: Wound check, suture removal
- 6 weeks: Weight-bearing progression reviewed
- 3 months: Strength, running clearance
- 6 months: Sport clearance; MRI if indicated
- 12 months: Final clearance
⚠️ Re-injury Prevention
- Always warm up before sport: 10 min minimum
- Continue hip and thigh strengthening lifelong
- Land with knees bent: never stiff-legged
- Stop if knee swells after activity: report early
- Do not rush: re-repair failure is permanent
🏠 Long-term Tips
- Avoid prolonged deep knee bending for several months
- Non-slip mat in bathroom: fall prevention
- Maintain healthy body weight: reduces load on repair
- Physio commitment determines outcome