During Rangers' Scottish Cup semi-final against St Johnstone in April 2008, St Johnstone player Martin Hardie stepped on Naismith's left knee and appeared to injure him. However, after initially limping off the pitch he returned to the field of play, only to collapse a short time later and required to be stretchered off. After cruciate ligament damage, Naismith underwent surgery in May 2008 (missing the club's UEFA Cup and Scottish Cup finals) and was ruled out of action for up to a year; however, he returned to training eight months later.