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

[Sammy Watkins' Rib]

Depends on the player. And perhaps the players age.

 

Frank Gore tore his ACL TWICE in college. Then went on to finish 3rd all time on the career rushing yards list in the NFL. 

 

Adrian Peterson tore his ACL and then had his best season ever the following year. 

 

Cooper Kupp tore his ACL and then went on to have one of the greatest seasons a receiver has ever had a few years later.

 

Gore and Kupp were young when they tore their ACL's. 

[Spiderweb]

What was Thurman Thomas's college injury? Seems he has a fine career, especially for a RB.

Just now, Spiderweb said:

What was Thurman Thomas's college injury? Seems he had a fine career, especially for a RB.

 

[Rocky Landing]

7 hours 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.

 

The average length of a cornerbacks career in the NFL is only 2.9 years, so I suppose Tre White is on on borrowed time in the first place? 

 

https://www.statista.com/statistics/240102/average-player-career-length-in-the-national-football-league/

[Mr. WEO]

This article can't be accurate.  I read right here that since Cam Akers recovered from a torn Achilles in 5 months, all ACL injured players come right back to full function.

[Stranded in Boston]

9 hours ago, Rubes said:

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.

 

 

Yeah, guys. I haven't looked at the article yet (maybe check out on PubMed later today), but without a control group, the results are impossible to interpret. Not to wonk out here (too much), but short of a matched cohort (which might be tough to assemble given small N) this is exactly where you'd need to apply some sort of nested multiple regression or proportional hazards model including ALL NFL players to first account for variance (in subsequent # years played) that is attributable to non-ACL factors like age, position played, previous injury history, previous # snaps (for non-overt related wear and tear), etc. -- and only then add the ACL/non-ACL factor to the model to see if it explains any residual variance. Pretty sloppy oversight if they didn't do that ... (They're lucky we at TBD didn't review their paper!  🤓  )

Edited April 6, 2022 by Stranded in Boston

[MPL]

Darrelle Revis is probably the closest comparison we have in terms of position, age, status, and playing style. 

Revis was 27 when he tore his ACL in week 3 of 2012. Over the next 3 seasons, Revis only missed 2 games and was named all-pro multiple times, made the pro bowl 3 times, and won the comeback player of the year award in 2013. Revis played a total of 5 seasons after ACL surgery, though he only played in a handful of games in his final season with the Chiefs. 

 

Obviously, anything can happen, but I'm expecting another 3 good years from Tre White. CB play declines significantly around age 30 so I think it's reasonable to assume that his play would naturally start to decline in the next few years even without the ACL surgery. Maybe he'll convert to safety at some point? That seems to be the best move for CBs who want to extend their careers i.e. Charles Woodson. 

 

 

[Rubes]

7 hours ago, Long Suffering Fan said:

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.  

 

Don't be so sure...most people in medicine are not trained to do research, and a good deal of research that is done is not done well. It's the job of the journal reviewers to spot problems with study design or analysis, and that process is fraught with issues—not the least of which is that reviewers aren't paid to do it, so you never know how carefully they do their job. Journals also gain from articles that draw attention, even if they are not done well, so there is a motivation in some cases to publish rather than reject. It's hard to tease apart.

 

Still, these authors are from Drexel and Duke, two pretty strong research universities, so it's a little surprising. The problem here is that they didn't use the right comparator group. They were comparing individuals pre- and post-injury, and comparing those who were injured and returned to play vs. those who were injured and never returned to play. The right comparator, as I mentioned earlier, would be those who were injured vs. those who weren't injured, matched based on their age, years of NFL experience, position, and maybe other factors like round they were drafted, whether they were a starter or backup at the time of injury, and so on.

 

Edited April 6, 2022 by Rubes

[offyourocker]

10 hours ago, Buffalo_Stampede said:

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. 

I also think the study should factor in player level.  I imagine a guy like Tre will get best of the best medical treatment and people focusing on his rehab.  I am sure a guy that is a non starter or on the practice squad will not nearly get the same 

[klos63]

10 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?

An article I read after Tre's injury stated that most players took a step back. A good player became a marginal player, a star player became a 'good' player.

Did people really think ACL tears were not that big a deal anymore?

[billykay]

10 hours ago, Buffalo_Stampede said:

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. 

Exactly. I'd like to know the average age of those who suffered an ACL injury. Then, I would like to see all the players in that age group. Then, see if there is a significant difference in who is still in the league three years later.

[Rocky Landing]

2 minutes ago, klos63 said:

An article I read after Tre's injury stated that most players took a step back. A good player became a marginal player, a star player became a 'good' player.

Did people really think ACL tears were not that big a deal anymore?

Yes. The worst part of an ACL tear (assuming there aren't other related injuries that have gone along with it-- MCL, meniscus, etc.) is the rehab. For several months, training, and conditioning become much harder, and some people might lose strength. But, reports have suggested that Tre's ACL was a clean tear. If he stays on top of his rehab, and takes advantage of what I assume are state-of-the-art rehab facilities at the Bills' Sports Performance Center, there is no reason he shouldn't return to full form.

[skibum]

I have had ACL reconstruction on both knees. One is basically 100% performance-wise, and the other is about 90%. Two ACL surgeries did not stop me from skiing at the highest level of my life. It also did not stop Frank Gore from having an amazing 16-year career at RB. 

 

I would say it depends on three things: (a) whether or not there was additional damage at the time of the injury (meniscus, other ligaments, etc). (b) the surgical procedure chosen, and (c) the laxity of the new ligament post-op.

 

For most of us, the primary surgery options are to harvest tissue from either your patellar tendon or hamstring to fashion a new ACL. This harvest is what causes lingering issues - patellar tendinitis, hamstring weakness. 

 

The deluxe option, which is what I figure the pros do, is to use tissue harvested from a cadaver. That way, there is no harvest site morbidity. There is an increased risk of a cadaver graft failing entirely, but if they don't fail they usually result in 100% recovery. 

 

A sloppy surgeon or over-aggressive rehab can result in the ACL graft becoming too slack, which allows the knee to bend too far the wrong way and maybe even slip out of joint laterally from time to time. 

 

Since pro athletes have the best surgeons and rehab coaching, its likely the only way Tre will have issues is if he did collateral damage to his cartilage at the time the ACL blew out. Being a non-contact injury, he probably didn't. 

[BADOLBILZ]

8 hours ago, Sammy Watkins' Rib said:

Depends on the player. And perhaps the players age.

 

Frank Gore tore his ACL TWICE in college. Then went on to finish 3rd all time on the career rushing yards list in the NFL. 

 

Adrian Peterson tore his ACL and then had his best season ever the following year. 

 

Cooper Kupp tore his ACL and then went on to have one of the greatest seasons a receiver has ever had a few years later.

 

Gore and Kupp were young when they tore their ACL's. 

 

 

Said it on here before..........but Frank Gore was a more physical version of Marshall Faulk before he tore up those knees............he was never anywhere near the same player.     He'd be talked about like Jim Brown or Walter Payton..........not just mentioned with them on the yardage list.

[Hapless Bills Fan]

12 hours 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.

 

 

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%).

 

The major problem I have with this is lack of matched cohort.

 

The joke is that NFL stands for "Not For Long"; the average overall career length in the NFL is 3.3 years, with 2.9 being the average for CB, 2.8 for WR, and 2.5 for RBs

https://www.statista.com/statistics/240102/average-player-career-length-in-the-national-football-league/

 

So given that, the right comparator likely isn't to players in other leagues post-injury, but to uninjured players at that position. 

 

The other big differentiators are probably skill and contract guarantees.  When a player has guaranteed money, or a high draft pick invested in him, or has been a star prior to his injury, being given time to get back to his old form is more likely.

 

The average player on a non-guaranteed contract is fighting for a "hat" every year.   If he tears an ACL, the team he's been playing in is obligated to pay for his medical care and rehab, but there's probably someone of similar skill level with two good knees in the draft or kicking around as a FA, so the injured player's chance of RTP are poor.  That may reflect a team's lack of interest in "taking a chance" on an injured player who may play at a lesser level his first year back, vs. a player of similar traits who is uninjured.

 

Consider Harrison Phillips.  The Bills had a 3rd round pick invested in him and few options on the roster at 1TDT when Star opted out in 2020.   He was NOT the same player when he initially returned from his ACL.  He was a "healthy scratch" for 4 games, and down to 23-33% of the snaps after that, until the very end of the season, and the Bills did move on from him this season, but they were patient with him in 2020 and 2021.

 

OTOH for a player like Justin Zimmer who was a low-level FA barely hanging on to the team with a 1 year contract in 2021, his ACL may well have ended his career.

[ToGoGo]

12 hours 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.

 

 

The first variable I would like to look at is age. 

 

NFL players don't last long regardless, so I assume there will be a natural drop-off for a 28 year old with or without an ACL injury. I'm curious how it affects a player in the 22-25 age bracket. 

 

Also, LB, RB, and DE are high contact positions. Seems to affect those who hit more than those who move fast. 

[Big Turk]

1 hour ago, klos63 said:

An article I read after Tre's injury stated that most players took a step back. A good player became a marginal player, a star player became a 'good' player.

Did people really think ACL tears were not that big a deal anymore?

 

Wasn't for AP who broke records like 6 months after his, or for Cooper Kupp who shattered records last year...

 

I'm not saying they aren't a big deal, I just think a lot has to do with the amount of work and effort someone puts into rehabbing it properly.

 

I had a hip replacement done...completely back to normal, run, lift, squat, etc...

 

A lot of other people are still using walkers after a year...why? A lot of reasons but not willing to work hard during rehab is probably high on the list. Rehab isn't suppose to be easy, it's supposed to be hard as hell and you have to push yourself to get great results in the end...

Edited April 6, 2022 by Big Turk

[Patrick Duffy]

9 hours ago, Sammy Watkins&#x27; Rib said:

Depends on the player. And perhaps the players age.

 

Frank Gore tore his ACL TWICE in college. Then went on to finish 3rd all time on the career rushing yards list in the NFL. 

 

Adrian Peterson tore his ACL and then had his best season ever the following year. 

 

Cooper Kupp tore his ACL and then went on to have one of the greatest seasons a receiver has ever had a few years later.

 

Gore and Kupp were young when they tore their ACL's. 

Yup agreed, also I would add depending how good the level of treatment/phy. therapy etc factors in also. I feel like when considering how top notch the Bills facility etc that is spoke of by many as being the best in the league, when taking that into account I can see Tre recovering a bit quicker than some may think.

 

 

[Bleeding Bills Blue]

26 minutes ago, Hapless Bills Fan said:

 

 

The major problem I have with this is lack of matched cohort.

 

The joke is that NFL stands for "Not For Long"; the average overall career length in the NFL is 3.3 years, with 2.9 being the average for CB, 2.8 for WR, and 2.5 for RBs

https://www.statista.com/statistics/240102/average-player-career-length-in-the-national-football-league/

 

So given that, the right comparator likely isn't to players in other leagues post-injury, but to uninjured players at that position. 

 

The other big differentiators are probably skill and contract guarantees.  When a player has guaranteed money, or a high draft pick invested in him, or has been a star prior to his injury, being given time to get back to his old form is more likely.

 

The average player on a non-guaranteed contract is fighting for a "hat" every year.   If he tears an ACL, the team he's been playing in is obligated to pay for his medical care and rehab, but there's probably someone of similar skill level with two good knees in the draft or kicking around as a FA, so the injured player's chance of RTP are poor.  That may reflect a team's lack of interest in "taking a chance" on an injured player who may play at a lesser level his first year back, vs. a player of similar traits who is uninjured.

 

Consider Harrison Phillips.  The Bills had a 3rd round pick invested in him and few options on the roster at 1TDT when Star opted out in 2020.   He was NOT the same player when he initially returned from his ACL.  He was a "healthy scratch" for 4 games, and down to 23-33% of the snaps after that, until the very end of the season, and the Bills did move on from him this season, but they were patient with him in 2020 and 2021.

 

OTOH for a player like Justin Zimmer who was a low-level FA barely hanging on to the team with a 1 year contract in 2021, his ACL may well have ended his career.

 

If he never plays again, and others like him - it definitely throws off the averages. 

[Bleeding Bills Blue]

1 hour ago, skibum said:

I have had ACL reconstruction on both knees. One is basically 100% performance-wise, and the other is about 90%. Two ACL surgeries did not stop me from skiing at the highest level of my life. It also did not stop Frank Gore from having an amazing 16-year career at RB. 

 

I would say it depends on three things: (a) whether or not there was additional damage at the time of the injury (meniscus, other ligaments, etc). (b) the surgical procedure chosen, and (c) the laxity of the new ligament post-op.

 

For most of us, the primary surgery options are to harvest tissue from either your patellar tendon or hamstring to fashion a new ACL. This harvest is what causes lingering issues - patellar tendinitis, hamstring weakness. 

 

The deluxe option, which is what I figure the pros do, is to use tissue harvested from a cadaver. That way, there is no harvest site morbidity. There is an increased risk of a cadaver graft failing entirely, but if they don't fail they usually result in 100% recovery. 

 

A sloppy surgeon or over-aggressive rehab can result in the ACL graft becoming too slack, which allows the knee to bend too far the wrong way and maybe even slip out of joint laterally from time to time. 

 

Since pro athletes have the best surgeons and rehab coaching, its likely the only way Tre will have issues is if he did collateral damage to his cartilage at the time the ACL blew out. Being a non-contact injury, he probably didn't. 

 

The context of the player matters here.  The number of ACL injuries is fairly static: https://www.nfl.com/playerhealthandsafety/health-and-wellness/injury-data/injury-data

 

I think the part that matters is - if you were already a fringe player and you tear your ACL, you're probably done.  Even if you come back exactly the same, you were already not an impact player.  There's a lot more to being a football player than running and cutting.  

[Mark80]

Where are the comparison numbers to players who didn't tear their ACLs?  What does it matter the ones that tore it are out of the league 71.5% of the time 3 years later if the ones who didn't tear it are also out of the league at a rate of over 70% in 3 years.