Yes, occasional knee pain at postoperative day 16 after ACL reconstruction with peroneus longus graft is completely normal and expected.
Pain, swelling, and range of motion limitations are common in the early postoperative phase after ACL reconstruction, and physical therapy modalities can help manage these symptoms during the first few weeks. 1
What to Expect at This Stage
At 16 days post-op, you are still in the acute recovery phase where the following are normal:
- Pain and swelling - These are expected findings during the first 2-3 weeks
- Range of motion limitations - Early mobilization protocols focus on gradually improving flexion and extension
- Occasional discomfort - Particularly with activity or exercise progression
The 2023 Aspetar guidelines specifically note that pain should be monitored during early rehabilitation, especially when progressing exercises 1. This doesn't mean pain is abnormal—it means it should be tracked to ensure it's not worsening or limiting your rehabilitation progress.
Early Phase Rehabilitation Context
According to current evidence-based guidelines 1:
- Isometric quadriceps exercises (static contractions, straight leg raises) can be safely performed during the first 2 postoperative weeks
- Early mobilization improves range of motion without compromising knee stability
- Pain medication use is common during the first 3 postoperative days, with gradual improvement expected
Recent research on peroneus longus grafts specifically shows that patients typically experience lower postoperative pain scores compared to hamstring grafts, with progressive improvement over time 2. One study found that donor site morbidity (including pain) improved significantly from initial postoperative assessments to 6 months, with most pain being mild 3.
Red Flags to Monitor
While occasional pain is normal, contact your surgeon if you experience:
- Severe, unrelenting pain not controlled by prescribed medications
- Increasing pain rather than gradual improvement
- Fever, warmth, or redness suggesting infection
- Sudden increase in swelling or inability to bear weight
- New instability or giving way sensation
Expected Timeline
Based on the evidence:
- Pain and swelling typically improve most dramatically during the first 3 postoperative days 1
- By 3 weeks, patients can typically progress to more advanced exercises like leg press 1
- Anterior knee pain should be monitored throughout early rehabilitation but generally improves with time
Your occasional pain at day 16 fits within the normal recovery trajectory—continue your prescribed rehabilitation protocol and maintain communication with your physical therapist about pain levels to ensure appropriate exercise progression.