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Three letters have haunted the Baltimore Ravens this season – A.C.L.
Rookie first-round running back J.K. Dobbins, linebacker L.J. Fort, star cornerback Marcus Peters, and veteran runner Gus Edwards, all tore their anterior cruciate ligaments in the space of a month. The Ravens were then forced into a quickfire roster rebuild on the eve of the 2021 season.
The patched-up Ravens took the field in their Monday Night Opener against the Las Vegas Raiders, and then it was an opposition player – guard Denzelle Good –who succumbed to a season-ending knee ligament tear. San Francisco 49ers' cornerback Jason Verrett also went down to the same injury in Week 1.
The question is, why are so many elite athletes, many of whom are at the peak of their careers, losing whole seasons to the dreaded torn ACL?
Why are ACL injuries so common?
The anterior cruciate ligament is the ligament that stabilizes a person's knee joint. Football is a game that asks a lot of that knee ligament, whether it's a receiver twisting while running a route, a runner bracing for impact or a defensive player driving into a tackle.
A tear occurs when there is a sudden stop or change of direction, and the ligament is under even more pressure when hundreds of pounds of muscle come crashing down on top of a planted leg.
Although surgical technology has improved drastically over recent years, a case-control study published in December 2019, shows that players with a successful ACL reconstruction have a 25% chance of suffering a recurrence of the injury.
However, there are many examples of players recovering from multiple ACL tears and having successful careers. The ultimate comeback story belongs to Carolina Panthers linebacker Thomas Davis, who tore his ACL in 2009, in the 2010 preseason, and again in 2011. He returned from a third knee reconstruction to play his best football, missing only three games in the next six years.
There has been much debate about whether synthetic surfaces, a trend towards lower tackling, a faster modern playing speed, or the length of the preseason – whether too long or short – has contributed to the volume of ACL tears, though there is no conclusive evidence.
Are ACL injuries on the rise in the NFL?
Data shows ACL injuries are more common during the preseason when players are striving to hit peak muscle fitness and cardiovascular shape, while familiarizing their bodies with football-related stresses on their joints.
There is evidence of an annual increase in ACL tears during the preseason every year between 2011 and 2018, but that regressed in 2019 and 2020. Over the past six years, there has been a fairly consistent total of ACL tears across the whole of the preseason and regular season combined – between 49 and 59 players.
That suggests that ACL tears are not on the rise, but they are still a serious problem. Every year around 20-30 players suffer a season-ending injury in the preseason and another 30-40 players are sidelined during the regular season.
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