Training After Knee Surgery: A Week-by-Week Plan

A practical week-by-week plan for getting back to training after knee surgery: what to do, how many sets and reps, and when to call your surgeon.

Knee surgery does not end in the operating room. It ends when your knee tolerates what you ask of it again. Most people make one of two mistakes: they push too early and spend months with a knee that swells every week, or they are so cautious that they lose half their quad before they ever start rebuilding. Here is a concrete schedule with numbers, plus one caveat that outranks everything else.

Your surgeon's protocol beats anything written here

ACL reconstruction, meniscus repair and partial meniscectomy run on three completely different timelines. After a partial meniscectomy you can usually weight-bear immediately and be back in the gym in 2 to 4 weeks. After a meniscus repair you often face 4 to 6 weeks of restricted flexion and partial weight-bearing. After an ACL reconstruction you are looking at 9 to 12 months before cutting sports. If this article and the sheet from the hospital disagree, the sheet wins.

Weeks 0 to 2: swelling, full extension, quad

The priority is not strength. It is getting the knee to straighten completely. Extension lost in the first two weeks takes months to get back.

Heel propped on a cushion, knee hanging free: 10 minutes, 3 to 4 times a day.
Quad sets: squeeze for 5 seconds, 10 reps, 4 to 5 rounds a day.
Straight leg raises: 3 sets of 10, with no lag at the start of the lift.
Ice and compression, 15 to 20 minutes, 3 to 4 times a day.
Walking around the house 5 to 10 minutes every 2 hours. Target by the end of week 2: roughly 90 degrees of flexion.

Weeks 3 to 6: range of motion and base strength

The stationary bike is the highest-value tool in this window. Start with back-and-forth rocking, and only go for full revolutions once flexion passes 105 to 110 degrees. Begin at 10 minutes and add 2 minutes every 2 to 3 days up to 25 to 30 minutes, with light resistance, around 3 to 4 out of 10 effort.

Mini squat to 60 degrees: 3 sets of 12.
Leg press in a 0 to 60 degree range: 3 sets of 12 at roughly 30 to 40 percent of body weight.
Glute bridge: 3 sets of 15.
Single-leg balance on the operated side: 3 rounds of 30 seconds.
Train your upper body normally, 2 to 3 times a week. There is no reason to lose that too.

Weeks 7 to 12: actual strength work

Now you are back to 3 to 4 sessions a week, 2 of them for legs. Work at 6 to 8 out of 10 effort, meaning 2 to 3 reps left in the tank, and add 2.5 to 5 kg per week for as long as your technique holds.

Bulgarian split squat: 4 sets of 8 per leg.
Romanian deadlift: 4 sets of 8.
Leg press, double leg then single leg: 4 sets of 10.
Step-ups onto a 20 to 30 cm box: 3 sets of 10 per leg.
Calf raises, straight and bent knee: 4 sets of 15.

After an ACL reconstruction, run the leg extension machine in a 90 to 40 degree range for the first three months and avoid heavy load in the last 30 degrees. A practical readiness test: 20 single-leg calf raises and 5 controlled single-leg squats with the knee not caving inward.

Months 4 to 6: running and jumping

Criteria, not dates. Before your first run: no swelling, full extension, and quad strength at least 70 to 80 percent of the healthy leg. The first session is 1 minute running and 2 minutes walking, 8 cycles, on flat ground or a treadmill. Increase weekly volume by no more than 10 percent. Add jumping only after 4 to 6 weeks of running with no reaction: double-leg hops first, 3 sets of 10, then single-leg.

Swelling is your measuring device

Pain up to 3 out of 10 during a session is fine if it settles back to baseline by the next morning. Swelling that builds and stays for 48 hours means the jump was too big. Cut volume by 30 to 40 percent and repeat the previous week. Measure knee circumference with a tape across the middle of the kneecap, once a week, always in the morning.

If your knee swells every Monday after training, the problem is not the knee. It is the plan.

Food and sleep

Protein at 1.6 to 2.2 g per kg of body weight daily. At 80 kg that is 130 to 175 g, easiest as 4 meals of 30 to 40 g.
Do not run a big deficit for the first 3 months. Cap it at 300 to 500 kcal below maintenance.
Sleep 7 to 9 hours. Under 6 measurably slows muscle recovery.
Nicotine and regular alcohol slow soft tissue healing.

When to see a doctor

Fever above 38 C, redness, warmth or drainage from the incision.
Calf pain with swelling in one lower leg, especially with shortness of breath. That is urgent, a possible clot.
The knee locks, catches or gives way under you.
You still cannot fully straighten the knee at 6 weeks.
Pain that increases day over day instead of settling.

The short version

Full extension and an active quad in the first 2 weeks matter more than any exercise you do later.
Weeks 3 to 6 are the bike and light restricted-range work; weeks 7 to 12 are real strength with 2.5 to 5 kg weekly progression.
Running is earned by criteria, not the calendar: no swelling, full extension, around 80 percent of the healthy leg's strength.
Swelling that lasts 48 hours means cut volume by 30 to 40 percent.
Your surgeon's protocol overrides any general plan, including this one.