Are ACL injuries no big deal anymore? The data suggest they are

[Rubes]

I'll admit that I've started believing that ACL injuries have become less of a concern in recent years, with players seemingly coming back to near pre-injury performance maybe the year after returning to play. Is that necessarily the case? Maybe not so much.

 

From the March 7th Orthopaedic Journal of Sports Medicine:

 

Return to Play and Performance After Anterior Cruciate Ligament Reconstruction in National Football League Players

(full article may be behind a paywall, but you can at least read the abstract)

 

Quote

Purpose/Hypothesis:
The purpose of this study was to compare return-to-play and performance levels by position in NFL players after ACLR (ACL Repair). It was hypothesized that (1) ACL injuries have significant effects on the careers of NFL players, including return to play and performance, and (2) players of certain positions that involve relatively less pivoting and cutting perform better after ACLR.

 

Quote

Methods:
All NFL players who underwent ACLR between 2013 and 2018 were identified using the FantasyData injury database. Player characteristics, snap count, games played, games started, and performance metrics were collected for 3 years before and after injury using the Pro Football Reference database. Performance was measured using an approximate value (AV) algorithm to compare performance across positions and over time.

 

 

Quote

Results:
Overall, 312 NFL players were included in this study, and 174 (55.8%) returned to play. Of the eligible players, only 28.5% (n = 59/207) remained in the league 3 years postinjury. Within the first 3 years postinjury, players played in fewer games (8.7 vs 13.7; P < .0001), started in fewer games (3.0 vs 8.3; P < .0001), had lower AVs (1.5 vs 4.3; P < .0001), and had decreased snap counts (259.0 vs 619.0; P < .0001) compared with preinjury. Quarterbacks were most likely to return to play (92.9% vs 53.7%; P = .0040) and to return to performance (2% vs 50% decrease in AV; P = .0165) compared with the other positions. Running backs had the largest decrease in AV (90.5%), followed by defensive linemen (76.2%) and linebackers (62.5%).

 

Quote

Conclusion:
The study findings indicated that NFL players are severely affected by ACL injury, with only 28.5% still active in the league 3 years after the injury. Running backs, defensive linemen, and linebackers performed the worst after injury. Quarterbacks were most likely to return to play and had superior postinjury performance compared with the other positions.

 

Obviously this is a population-level study, and conclusions at the population level don't necessarily apply to a particular individual and his specific injury. Not all ACL injuries are the same, depending on the nature and extent of the ligament injury. It is also specific to positions: interestingly, WRs were similar to QBs in losing only about a quarter (18% and 17%, respectively) of their total snap count postinjury. So perhaps something to consider with regard to someone like Jameson Williams.

 

But still, this is a pretty sobering study, though I haven't gone through it in great detail to critique the methods. It's important to bear in mind that their study group was only up to 2018, so any improvements in ACL repair since then are not taken into consideration. Also of interest, they note that "NFL players have significantly shorter careers postoperatively (2.1 years) compared with players in other professional leagues such as the National Basketball Association (NBA; 4.5 years), National Hockey League (NHL; 4.5 years), and Major League Baseball (MLB; 2.9 years)."

 

Overall, ACL injuries are still bad news for NFL players who aren't QBs. Thought some of you might be interested to read that.

 

[Warcodered]

Less of not a big deal and more of not a death sentence anymore.

[BruceVilanch]

I think of them like Tommy John surgery in baseball. The recovery process and treatment has come a long long way, but it is still definitely something that can affect performance long term. 

[StHustle]

Are factors such as the players being a year older and often a whole season removed from playing (rusty when first returning)?

[Gugny]

21 minutes ago, Rubes said:

I'll admit that I've started believing that ACL injuries have become less of a concern in recent years, with players seemingly coming back to near pre-injury performance maybe the year after returning to play. Is that necessarily the case? Maybe not so much.

 

From the March 7th Orthopaedic Journal of Sports Medicine:

 

Return to Play and Performance After Anterior Cruciate Ligament Reconstruction in National Football League Players

(full article may be behind a paywall, but you can at least read the abstract)

 

 

 

 

 

Obviously this is a population-level study, and conclusions at the population level don't necessarily apply to a particular individual and his specific injury. Not all ACL injuries are the same, depending on the nature and extent of the ligament injury. It is also specific to positions: interestingly, WRs were similar to QBs in losing only about a quarter (18% and 17%, respectively) of their total snap count postinjury. So perhaps something to consider with regard to someone like Jameson Williams.

 

But still, this is a pretty sobering study, though I haven't gone through it in great detail to critique the methods. It's important to bear in mind that their study group was only up to 2018, so any improvements in ACL repair since then are not taken into consideration. Also of interest, they note that "NFL players have significantly shorter careers postoperatively (2.1 years) compared with players in other professional leagues such as the National Basketball Association (NBA; 4.5 years), National Hockey League (NHL; 4.5 years), and Major League Baseball (MLB; 2.9 years)."

 

Overall, ACL injuries are still bad news for NFL players who aren't QBs. Thought some of you might be interested to read that.

 

 

What are you?  Some sort of ***** doctor, or something??!??

[Buffalo_Stampede]

Age is probably the biggest factor in returning to a high level of play.

 

That should have been part of the study. A 25/26 year old player vs a player 30+ years old. I’m sure there’s a difference.

 

For healthy RB’s you could probably find huge playing time and performance decreases even before 30 years old. 

[gonzo1105]

And in this study, how many players who tore their ACLs were contributors, good players, guys who still would have been in the league 3 years later. 
 

Running backs were depicted as one of the worst positions for the study. Absolutely tough to come back from as an RB but we know how NFL teams value RBs in general. Oh he tore his ACL guess I’ll just draft another cheap option. 
 

I think more insight needs to be done on this type of study 

Edited April 6, 2022 by gonzo1105

[billsfanmiamioh]

Low quality evidence, selection bias present. Shouldn’t they have tested this against the nfl population as a whole? Isn’t the “average” nfl career like 4 years? 

[Buffalo_Stampede]

3 minutes ago, billsfanmiamioh said:

Low quality evidence, selection bias present. Shouldn’t they have tested this against the nfl population as a whole? Isn’t the “average” nfl career like 4 years? 

I skimmed it but age doesn’t get mentioned either. Age would be a huge variable in a study like this. I wonder why they would leave that out?

[Big Turk]

3 minutes ago, Buffalo_Stampede said:

I skimmed it but age doesn’t get mentioned either. Age would be a huge variable in a study like this. I wonder why they would leave that out?

 

Perhaps many of the players were not that good to begin with?

 

What's the success rate for "star" caliber players?

[BuffaloRebound]

1 minute ago, Big Turk said:

 

Perhaps many of the players were not that good to begin with?

 

What's the success rate for "star" caliber players?

Yes.  Really hard to come to a conclusion when you don’t include the statistics for the population of players who didn’t suffer ACL injuries.  

[Rubes]

7 minutes ago, BuffaloRebound said:

Yes.  Really hard to come to a conclusion when you don’t include the statistics for the population of players who didn’t suffer ACL injuries.  

Yep, I’m thinking they should have done a matched cohort study where they matched each player who suffered an ACL injury with players of the same age, years in the NFL, and position at the time of injury. Perhaps also include whether they were a starter or backup. Then you’d at least get a better sense of the impact of the injury on career metrics like starts, total plays, and so on as compared with similar players who didn’t suffer that kind of injury.

 

 

Edited April 6, 2022 by Rubes

[Doc Brown]

I wish they would’ve added a non injury control group in this study.  Obviously a torn ACL will shorten many careers but without a control group it’s impossible to know to what extent.

[BADOLBILZ]

23 minutes ago, billsfanmiamioh said:

Low quality evidence, selection bias present. Shouldn’t they have tested this against the nfl population as a whole? Isn’t the “average” nfl career like 4 years? 

 

 

The average NFL career is just over 3 years.

 

My first thought when I saw the title was whether the OP realized this.

 

Most of the players that suffer ACL injuries are barely hanging on to an NFL job............because most players in the NFL are barely hanging onto a job.

 

I'd also think that players who make a lot of money find it much easier to rehabilitate from injuries.

 

I think the answer is that ACL injuries are much easier to come back from now than they were even 10 years ago.

 

As for what @BruceVilanch said about Tommy John surgery.........the difference there is that A LOT of TJ patients actually come back throwing harder than ever before.   I don't think there is any evidence that the ACL repairs have had a positive affect beyond getting players back to where they once were or close to it.

Edited April 6, 2022 by BADOLBILZ

[MJS]

I think they used to basically be career ending injuries. Now we are at the point where players can at least come back and make a go of it.

[John from Riverside]

I’ve seen this football injury firsthand no it’s not a walk in the park

[BillsfaninChicago]

It sure does make me feel out of shape when at 39 a leg cramp jogging with my dog is a big deal for me!

[Thurman#1]

1 hour ago, Rubes said:

I'll admit that I've started believing that ACL injuries have become less of a concern in recent years, with players seemingly coming back to near pre-injury performance maybe the year after returning to play. Is that necessarily the case? Maybe not so much.

 

From the March 7th Orthopaedic Journal of Sports Medicine:

 

Return to Play and Performance After Anterior Cruciate Ligament Reconstruction in National Football League Players

(full article may be behind a paywall, but you can at least read the abstract)

 

 

 

 

 

Obviously this is a population-level study, and conclusions at the population level don't necessarily apply to a particular individual and his specific injury. Not all ACL injuries are the same, depending on the nature and extent of the ligament injury. It is also specific to positions: interestingly, WRs were similar to QBs in losing only about a quarter (18% and 17%, respectively) of their total snap count postinjury. So perhaps something to consider with regard to someone like Jameson Williams.

 

But still, this is a pretty sobering study, though I haven't gone through it in great detail to critique the methods. It's important to bear in mind that their study group was only up to 2018, so any improvements in ACL repair since then are not taken into consideration. Also of interest, they note that "NFL players have significantly shorter careers postoperatively (2.1 years) compared with players in other professional leagues such as the National Basketball Association (NBA; 4.5 years), National Hockey League (NHL; 4.5 years), and Major League Baseball (MLB; 2.9 years)."

 

Overall, ACL injuries are still bad news for NFL players who aren't QBs. Thought some of you might be interested to read that.

 

 

 

If "of the eligible players, only 28.5% (n = 59/207) remained in the league 3 years postinjury," is your headline here, you're right that it is a bit shocking, but less so when you remember that the average NFL career is 3 years.

 

But yeah, they're not nothing. You can't just assume things will be hunky-dory automatically.

[Buffalo_Stampede]

2 hours ago, Big Turk said:

 

Perhaps many of the players were not that good to begin with?

 

What's the success rate for "star" caliber players?

We can use the “ started in “ results. Here they state these players started about half (8.3) the games. So I would guess about half of the players studied were full-time starters. Even less would be above average starters.

 

 

 

Edited April 6, 2022 by Buffalo_Stampede

[Long Suffering Fan]

2 hours ago, Buffalo_Stampede said:

I skimmed it but age doesn’t get mentioned either. Age would be a huge variable in a study like this. I wonder why they would leave that out?

 

38 minutes ago, Thurman#1 said:

If "of the eligible players, only 28.5% (n = 59/207) remained in the league 3 years postinjury," is your headline here, you're right that it is a bit shocking, but less so when you remember that the average NFL career is 3 years.

 

It is hard to know the motivations behind people and why they would leave that out (pre-determined conclusions, wanting a paper that had a newsworthy conclusion, funding, less nefarious things), but I refuse to believe that they didn't consider it.  If a bunch of yahoos, including myself, immediately point that out on TSW, I can't imagine that a group of intelligent researchers publishing a paper didn't think of it.  

 

2 hours ago, Warcodered said:

Less of not a big deal and more of not a death sentence anymore.

 

That is so true.  Back in the day, you just had to live with it, which likely meant no more competitive sports.  It was the old "Trick Knee".  Without the ACL, you were just so much more likely to pop it out of joint momentarily.  I found that out when I tore mine in my 40s.  My knee swelled, but I had no idea that I had torn it.  I was out of town so I just iced it and rested it.  When I got back in town it was actually feeling pretty good.  Three weeks after the injury I was running on it aggressively.  Then I started playing sports again and I kept tweaking it.  I thought I better get it checked and, when they told me it was a torn ACL, you could have knocked me over with a feather.  

 

I remember really liking Jeff Nixon - four takeaways against the Dolphins in 1980 to help break our 20 game losing streak against them.  Then one year he gets a knee injury (in his mid to late 20s - his prime) and never plays again.  I think that was ACL, but I don't remember for sure.  It was a death sentence for his career.