How Long Does it Take A Running Back to Recover From An ACL Injury?

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Surprisingly, one of the biggest concerns from Packers fans is depth at running back (personally I would have put safety as my top concern).  Fans are worried that the combination of James Starks, Alex Green and Brandon Saine may not be enough to take pressure off Aaron Rodgers and the passing game.  One thing that I think fans have missed is that Alex Green isn’t exactly ready to play, after suffering a brutal ACL injury during week 7 of the 2011 season, whether or not he can be a significant contributor for the offense in 2012.  On the flip side, while Packers fans should not hold ill will against Adrian Peterson, who also injured his ACL (as he is a class act and a great football player), let’s just say Packers fans are hoping to see Peterson in sweat pants during week 13 and week 17.

I wanted to know a little more about ACL injuries in general and their effect in the NFL, so enter in “Outcomes of Anterior Cruciate Ligament Injuries to Running Backs and Wide Receveirs in the National Football League” by Brian J Sennett MD et al. which was published in the American Journal of Sports Medicine, volume 34, no. 12 1911-1917.  Sennnett et al. looked at 33 running backs and 31 wide receivers that had suffered an ACL injury while on a NFL roster between 1998 and 2002 and analyzed their performance compared to players in their respective positions who had not suffered an ACL injury.  The results are not good.

1. Players on average take 55.8 weeks to recover from an ACL injury:The range for the time of recovery for players suffering an ACL injury is from 40 to 187 weeks.  Keep in mind this does not factor in the offseason where a player may be healthy and capable of playing but cannot return to the field as there are no games to play and the specifics of the injury (such as additional MCL damage and the severity of the injury)

Alex Green: Injured on October 23rd, 2011.

  • Best case scenario for return: July 29th, 2012 (training camp)
  • Average case scenario for return: November 18th, 2012 (at the Lions, week 11, which is the week after the bye)
  • Worst case scenario for return: May 24th, 2015
  • Conclusion: While news coming out of OTAs was largely vague but positive, I wouldn’t be surprised to see Green start the season on the PUP, which would already deplete a running back core with injury issues.

Adrian Peterson: Injured on December 20th, 2011

  • Best case scenario for return:  September 30th, 2012 (at the Lions, week 4)
  • Average case scenario for return: January 24th, 2013 (after the regular season)
  • Worst case scenario: July 15th, 2015
  • Conclusions: Peterson has vowed to be ready for the start of the season, but as no running back or wide receiver made it back that quickly between 1998-2002 and considering that Peterson blew out both his ACL and his MCL, chances are good that he misses the entire season.  Then again AP is no ordinary running back so maybe he will be the statistical outlier.

2. Players coming off an ACL injury on average produce 65% less during the 3 years after the ACL injury compared to the 3 years before the ACL injury:Based on the author’s use of the “power rating” (which factors in yards gained and touchdowns scored), players on average can expect to see their production drop 35% after an ACL injury, which isn’t surprising as while a player may be able to step onto the field and play football, whether they will be able to perform at 100% is a completely different matter.

 

 

Alex Green: Considering that he was a rookie in 2011 and didn’t get much time on the field before his injury, I will instead be using the averages of his 2 years at Hawaii instead (Green played for Aaron Rodgers’ alma mater Butte Community College as a sophomore so he only had two years of playing time in a major football program).

  • Before ACL injury: 826 yards, 10 TD
  • 3 year average after ACL injury (projected): 537 yards, 7 TD

Adrian Peterson: I’ve included Peterson’s 2011 season as part of his 3 year average since he was placed on IR after week 16, meaning he only missed one game and since it was the last game of the season on a 3-13 team, it’s debatable if Peterson would have seen much time on the field anyways.

  • Before ACL injury: 1217 yards, 14 TD
  • 3 year average after ACL injury (projected): 791 yards, 9 TD

3. 80% of running backs make it back into the NFL after an ACL injury:On the flip side this also means that there’s a one in five chance that Alex Green and Adrian Peterson don’t make it back to the NFL, however my own opinion is that both will be around for a couple more seasons.

Alex Green: Since Green was injured during his rookie season, chances are very good that the Packers front office isn’t ready to cut their losses with their 3rd round selection.  Add to that his contract is quite manageable and has him locked up until 2014 and I can’t imagine he isn’t with the Packers.  Simply put that Packers still don’t know what they have in Green and they aren’t going to cut him until they do and it isn’t costing them much to wait and see, so they will wait for him to recover.

Adrian Peterson: Peterson is literally the heart and soul of the Minnesota Vikings and again there’s no way that the Vikings drop him, especially not after signing him to a 7 year contract worth $96 million last year, including $36 million guaranteed.  The Vikings literally cannot afford for Peterson not to be on the team, and when you consider their depth at wide receiver and quarterback, Peterson is the Vikings offense.

Overall, I don’t think it would be a terrible blow for the Packers to have Alex Green start out on the PUP, for one the Packers offense is built around the pass and Aaron Rodgers has managed to produce at a MVP level without a dangerous running game for the entire time he’s been a starter.  I would also argue that if Green can indeed produce around 500 yards and a couple touchdowns, that in conjunction with James Starks, Brandon Saine, John Kuhn and Aaron Rodgers would be good enough to keep defenses honest; I think it’s important to point out that while the Packers are unlikely to have a 1,000 yard rusher on the 2012 roster, as long as the Packers rush for over 1,000 yards as a group (hopefully Rodgers doesn’t contribute a large proportion of these yards scrambling)  I think the effect will be the same.  And for all you Ryan Grant lovers out there, if Alex Green does start on the PUP, the logical conclusion would be that Grant takes his place (if he isn’t on another team at that point).

On the flip side, the Viking are pretty much screwed without Adrian Peterson; Christian Ponder can expect to see a lot more  cover-3 and nickel with 3/4/5 men in the box and while he may be a quality quarterback in the future, he’s only a 2nd year player who probably isn’t ready to hold up the team and the roster around him isn’t exactly going to give him any help.

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Thomas Hobbes is a staff writer for Jersey Al’s AllGreenBayPackers.com.

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  • steve cheez

    Wow! How many other Packer sites can you go to and find analysis based on citations from the American Journal of Sports Medicine? I feel smarter just by logging on here!

    • Thomas Hobbes

      Thanks, if you have any other questions, I’d be more than happy to look into them, I’ve definitely written articles based on previous comments.

  • steve cheez

    Just curious, is there any history of Packer RBs coming back from ACLs? Is that what essentially ended the career of Eddie Lee Ivery?

    • Thomas Hobbes

      Off the top of my head I can’t think of any, but I would assume that Packers RBs aren’t special compared to other team’s RBs in terms of their ability to recover from an ACL injury.

    • Buddy

      Do not look into the history of ACL injuries in the NFL. Success rate of ACL repairs has increased significantly over the past few years… Any 10 year old article discussing ACL repairs is very outdated even if its from a reputable peer reviewed journal.

      • Thomas Hobbes

        I agree that the surgery techniques used now versus in 1998 are undoubtedly better, but the human capacity to recover is still going to be the same so there is merit to this study.

        • CSS

          Slight quibble: I would say the capacity to recover is directly proportionate to the modern protocol and changes in technique over the last decade.

          Now replace ‘human capacity’ with ‘psyche’ and you’re spot on. That hasn’t changed in a decade: The fear of getting hit or injuring it again. Those folks still get on the field more slowly, run with hesitation and delay their own recoveries.

  • ThomasMagnumPI

    I think that we can bump these estimates up a bit, given the medical advancements that have taken place since Dr. Sennett’s studies took place. I’ve heard that the average recovery is down to the 55-week range nowadays, so hopefully Green regains his explosion by midseason, and he is ready to contribute in a limited capacity from week 1.

    I’m excited to see what Green has in him!

    • Ron LC

      First, thanks for the info to TH. Very informative stuff.

      Next, I’m in agreement with TMPI on the advances made in joint surgery over the 10 years not covered by the study (2003-2013). I’m not sure exactly how that impacts recovery time, but my guess is that it is less than the past.

    • CSS

      I run multispecialty surgery center that includes orthopedics. We do reconstructive knee surgery on an outpatient basis (ACL/MCL repairs are up and out of the facility 2-4 hours post-operatively these days) and can tell you these procedures have really advanced in the decade since this sample size was pulled.

      Basically, even amateur athletes bear weight on the repaired joint as soon as they can tolerate pain, with rehabilitation beginning shortly afterwards. It’s all about how quickly you can build the muscle mass surrounding the joint and increase blood flow to the repaired ligaments.

      The only thing inhibiting performance for guys like Peterson and Green is the fear of being in the pile. I’ve personally had my knee reconstructed twice, and played football afterwards (early 90’s). The return performance is purely mental and getting over being hit again and rolling to the turf.

      Good approach on the article, interesting read.

      • Thomas Hobbes

        Since you would know, how much more severe is tearing your ACL versus tearing your ACL and MCL? As far as I know Green only tore his ACL while Peterson tore both his ACL and MCL. Presumably both had just one surgery, but does destroying your MCL to boot make recover slower or the same?

        • CSS

          The combination of your ACL and MCL is more sever. ACL repairs are really routine at this point with stability of the repaired joint typically more stable, if not stronger than the original structure you were walking around with.

          Long-term, cartilage is worse. You can repair it or replace it. What’s key for both of the above, did they also rupture and lose cartilage. You’re career longevity is on the clock if you did.

          I know for a fact that Chris Cook, Vikings DB tore up his cartilage his rookie year. They can talk up his progress all they want, but he’s bone on bone with no cushion. On artificial turf, that kid will have a limited career with constant swelling.

          • ThomasMagnumPI

            I heard some bad news about Sherrod’s recovery as well–any thoughts on the “setback” that he suffered this spring (according to MM from Jason Wilde’s twitter)? I know it’s not ligament damage to the knee, and hopefully not cartilage damage, but what could the setback be?

            I know the injury looked horrific, but my understanding is that once the bones have healed and the leg muscles are strengthened, it should not be a long-term issue. Is that about right, or am I missing something?

            • Thomas Hobbes

              The only thing that was officially reported was the Sherrod broke his leg, which to me means that he broke the a bone in his right leg. If that’s the extent of the injury, then there shouldn’t be any ACL/MCL/meniscus damage, but given breaking your leg is bigger news than tearing a ligament, maybe that fact got washed out in the news.

              The other factor to consider is that while your muscles will atrophy when you break your leg, you only have to re-strengthen them to it’s original state to get back to normal as repaired bone is pretty comparable to normal bone (since your bones are constantly being “repaired” throughout the course of your life). With ligament damage however, you actually need stronger muscles than before because the muscles now have to compensate for the ligament damage.

              TLDR; Sherrod should have an easier time coming back from a broken leg than Green coming back from a torn ACL.

            • CSS

              They offered no detail and likely won’t. I heard the press conference and I’m assuming the setback was related to the anticipated time to recovery (timeline) and had nothing to do with additional or unreported injury.

              He should really be a PUP candidate and just let the kid recover and get his mind right. I’m assuming they’ve planned for the possibility.

              • ThomasMagnumPI

                Seems about right to me. Get Datko ready to be the swing tackle for now, Dominguez (sp) and EDS on the inside and get Sherrod ready by mid-season.

                Man, if GB could get Datko healthy (gameday inactive after Sherrod is ready by Week 6 hopefully) along with Newhouse, Bulaga and Sherrod, they could have the deepest bookend group in the league.

          • Thomas Hobbes

            On that thought, is it more likely to suffer meniscus damage when tearing both your ACL and MCL? Does the surgery damage the meniscus as well? (I would assume no with arthoscopic surgery) My assumption would be that tearing both ACL and MCL results from a more severe impact, would this also mean there’s a higher chance of cartilage damage as well? While cartilage damage might not be a short term problem, would it lower AP’s already short shelf life? (I mean look at how the guy runs)

          • Mojo

            CSS, you say that the joint is often more stable than the original structure, am I to suppose the actual ACL is stronger also? What I’m trying to get to is; lets say Green makes a hard cut, are you saying his ACL is less likely to tear than it was originally, assuming the ligament was given the proper amount of time to heal? Or is it the increased muscle-mass around the ligament that is providing a false sense of security regarding the susceptibility of the ligament to re-tear?

            • CSS

              When I say, ‘the joint is often more stable’, I’m referring primarily to the ACL. Basically, it stabilizes the leg for lateral movement which is crucial for any athletic endeavor. Almost everybody has some type of structural weakness in the body, nobody was born with perfect anatomical integrity, especially in the joints (specifically connective ligament tissue and how your anatomy aligns). So yes, a surgeon can repair an ACL with the ideal tension and placement you may not have had to begin with. I myself was told I had ‘loose ligaments’ they have a device in physical therapy that can basically measure stability and integrity of the ligament/joint.

              The combination of muscle mass and new joint integrity can make the joint more stable. That being said, you are really at risk when you tear the repair. That’s a different ballgame.

              The false sense of security is just the psyche and human nature. Being tackled at angle ‘X’ led to damage/pain/sensation ‘Z’ last time I was hit. It’s hard to shut off your mind when you see a comparable tackle coming and that’s when you’re even more likely to get hurt, when you hesitate.

              Really, you just need to get hit hard once in the league or be at the bottom of a pile to realize repeating the event is remote and you can go back to reacting and not thinking.

    • Thomas Hobbes

      I thought of that as well; I’m not sure exactly what sort of procedures they did back in 1998, but with advances in arthroscopy technology, I think the incision sizes are a lot smaller now, which usually translates to faster recover time. How much this effects a players ability to recover I don’t know. It would be interesting to see what the Packers do if Green is projected to be ready say by week 4, do you give up and put him on IR? Stick him on the PUP? Or leave a spot on the roster for him?

  • Ed Schoenfeld

    What Magnum PI says, plus did anyone notice that the post-injury power rating for the study backs was about the same s the control group? That suggests that most RBs coming back from the injury will be ‘average’ NFL starters, while some (AP?) will be better.

    • Thomas Hobbes

      The data is a little skewed, and the authors do mention this point. They argue that players who are most likely to suffer an ACL injury are those who are on the field the most, i.e. players who better than the norm. The data is also skewed by the fact that players are only included if they managed to play 3 years after the surgery. A unknown rookie free agent suffering a ACL injury is less likely to be retained through the injury than say Adrian Peterson

  • Pat Mc

    I agree with everything said. Cheaper than AP and if averages work out Green gets 7 TD to AD’s 9. Start Green on PUP and give the free agent RB’s a shot. WHo knows, there might be a star there to develop. In six weeks activate Green for the second half of the season and place the young guy onto the development squad.

    • Thomas Hobbes

      The really big caveat here is that Green’s numbers are based on his days at Hawaii and I’ll be the first to admit that production in college doesn’t always translate into production in the NFL. For instance, Green had an career average yards per attempt of 7.1 with his 2010 season averaging 8.2 yards (with 1,199 total yards), which is simply unheard of in the NFL.

  • Nerdmann

    They have been saying all along that Green is coming along very well compared to average recovery time.

    That said, our staff is very conservative. He’ll be on a pitch count at minimum.

    You’re also writing off the rookies, Tyler and Bennet. It’s not inconceivable that one of those guys makes the team.

    • Thomas Hobbes

      I’m not writing off the undrafted rookie free agent running backs more than I am pandering to the Ryan Grant lovers :) Though in all seriousness if Ryan Grant is around once training camp starts and the team gets a better idea how far along Green is, I wouldn’t be surprised to see Grant back on the team, especially with the 90 man roster where the Packers can see Grant compete against Tyler and Bennett

      • Tarynfor12

        I would think Grant has no interest in competing against two UDFAs…he will wait for a deal to play on a team.If Tyler and Bennet show nothing valuable by week 3 preseason and Grant is still by the phone…TT more likely calls then,maybe?

        • Thomas Hobbes

          Given how long he’s been on the free agent market, I don’t think he’ll have a choice, he’s going to be competing with undrafted rookie free agents and 3rd string running backs regardless of what team signs him. He’s not going to be signed to be the feature back (or he would be on a team by now), he’s really just fighting for a roster spot at this point.

  • Mojo

    I don’t think Green will end up on the PUP list because the Pack plan on practicing him. However, if it gets to around mid-August and Green hasn’t played or practiced yet, I would take that as an indication the Pack are going to PUP him for sure and if Grant’s available, put in a call to him.

    • Thomas Hobbes

      I’m not sure Green Bay would “strategically” place Green on the PUP, if he can play they want to see him compete, if he can’t then he goes onto the PUP

    • ThomasMagnumPI

      Also another reason NOT to put Sherrod on the PUP (I forgot this point in my earlier post). PUP=Physically Unable to PRACTICE . . .

      Sherrod needs all the reps he can get, IF he is physically ready.

      • Thomas Hobbes

        Well if he can’t practice cause of his injury he can’t practice. I would assume given the he was a 1st round pick his spot on the team is essentially secure, so really there is no reason to stash him on the PUP; you paid a 1st round pick to get him and that means he has to contribute immediately (not saying he can, but that’s how the league works).

  • Oppy

    I don’t believe Alex Green’s ACL should be classified as brutal, necessarily. I believe it was a partial tear, not a complete detachment or tear, and (i think?) that’s a good thing.

    Also, the Packers have been very optimistic about Green’s prognosis from the get go, so Dr. McKenzie must not have been too worried about the state of Green’s knee once he got in there.

    There was an article about a month or two ago that stated that Green has been aggressively rehabbing, on a daily jogging routine, able to full-speed run and quick sprint, and was just starting to do some cutting.

    My completely uneducated guess is that he could be available to play come the season opener, but I don’t think he’d be much use till at least mid season. I do think the Packers could PUP him (he won’t be happy about it, but it would be in his best interests) and the Packers will use his roster spot to get an extended look at Marc or Du’ane until week 8.

    Now, if you want to talk about brutal knee injury… Andrew QUarless.. Yikes. that could be a career destroyer.

  • http://corkasoltysa.wordpress.com/ Maire Nevwirth

    The very next time I read a blog, I hope that it doesn’t fail me as much as this particular one. I mean, I know it was my choice to read through, but I actually thought you would probably have something interesting to talk about. All I hear is a bunch of complaining about something that you could fix if you weren’t too busy seeking attention.