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Crank the AC(L): Saquon’s Recovery & 2021 Outlook

Erik Kreil brings the heat with his analysis of ACL injuries and Saquon Barkley’s 2021 dynasty outlook.

By Erik Kreil, DPT, PT, OCS, CSCS

Find me and my medical friends talking more about sports injuries on the Ride or Dynasty podcast “The Next Man Up” on Spotify. 

Everyone loves a comeback story, except in fantasy football it seems.  Saquon Barkley burst onto the scene after being drafted #2 overall in 2019.  Since then, Saquon accumulated 3,469 all-purpose yards, 23 all-purpose touchdowns, and 143 receptions in his first 2 healthy seasons.  However, fantasy managers have been divided into 2 camps after the crazy 2020 year when he suffered an early ACL injury: the stead-fast Saquon truthers and the doomsday negative Nancies, who believe the injury will have a permanent effect on his fantasy value. What will happen?  Will Saquon Barkley have an Adrian Peterson-esque return, or is his career on the clock? 

We’re going to primarily reference 2 research papers:  

  • “Return to Play Rates in NFL Wide Receivers and Running Backs After ACL Reconstruction” by Monoharan et al. from The Orthopaedic Journal of Sports Medicine in 2021. 
  • “National Football League Skilled and Unskilled Positions Vary in Opportunity and Yield in Return to Play After an Anterior Cruciate Ligament Injury” by Yang et al. from the Orthopedic Journal of Sports Medicine in 2017. 

Both of these papers analyze career length and 2 year post-operative player performance, so we’ll limit our commentary to these 2 topics.  Since they also give data on WRs, I’m including Courtland Sutton in this commentary.  Sutton is an intriguing dynasty dark horse and may be overlooked in redraft leagues.  

Here’s why this commentary is different than others I’ve read:  

Analyzing only a recent athlete cohort is important. 

Surgical techniques, rehab protocols, NFL rules/ play style, and the athletes themselves have all changed notably, which is why I like the data from the first reference the best.  It analyzes injured athletes from 2009/2010-2015/2016.  This is recent enough to be comparable to current athletes while being distant enough to see many players’ full career arcs.  

Even better, the first reference uses a matched control group to help make comparisons even more fair.  

Other commentaries I’ve read only answer the question very vaguely: Are RBs affected by ACL operations?  But, they compare every RB equally (Saquon Barkley vs Tim Hightower).  That’s like comparing apples to oranges, since they’re both fruit.  We need to further divide the cohort into athlete quality. We’ll talk about that later. 

Let’s begin! Post-op performance… 

First, we need to know if Saquon Barkley and Courtland Sutton will even be ready for their season openers.  They can’t perform if they don’t play.  In these studies, RBs took about the same time as WRs to return to the field, if you exclude 1 RB who took 47 months to return.  The median time is ~12 months.  No player in the analysis returned before 9 months.  Saquon and Courtland will be at  ~12 months since injury when the 2021 season begins. 

So, will they be just as fast, agile, and powerful?  In 2015, Keller et al. studied “NFL Combine athletes with a history of primary ACL reconstruction to determine if they will perform similarly to matched controls in the 40-yd dash, vertical leap, and other tests of agility and quickness.” They were the same. 

Alright, but how will they perform on the field?  1st and 2nd year post-op performance measures of Yards/ reception (or rush for RBs), Receptions (Rushes) / game, and Receiving TDs (Rushing TDs) / game were analyzed.  “For each of the 3 performance categories, the WR group had significantly decreased performance after ACL surgery when compared with pre-injury performance.”  RB performance trended down in all 3 stats but only with statistical significance in yards/ rush.  On average, WRs performance suffers more than RBs after ACL, and while there’s a general downtrend for RBs the only measure that changed large enough to not be accountable to chance was yards/ rush. 

Fantasy take-away: Saquon may start slow but should return to form by mid-season, while Sutton has a bigger hill to climb. 

What about career length? 

Keefer et al. examined the “sunk-cost fallacy” in the NFL. They found that “first-round selections… started significantly more games [after ACL compared to later round athletes] because of their compensation premium.”  RBs drafted higher were given “better and more opportunities after an ACL injury” because of both the athletes’ “intrinsic talents and extrinsic investment valuation.”  Saquon was drafted #2 overall, Sutton was drafted #40 overall. 

Brophy et al “reported similar career lengths in NFL athletes with and without ACL reconstruction but shorter career lengths in players who underwent ACL reconstruction with associated meniscectomy.”  Neither player had a menisectomy. 

It was also determined that athletes who were starters before the ACL injury played more games after the surgery.  The better the player stats prior to injury, the more games they played after the injury, as well.  Better players’ careers are less affected by ACL operation. 

Fantasy take-away: Both Saquon and Sutton should have comparable career lengths to their peers. 

Now for the hard part. How do we compare anyone on this list to Saquon Barkley?  


@Mathbomb’s work creating RAS scores at is amazing.  Seriously. Saquon’s physical metrics are almost off the charts in every category, which is why he was drafted #2 overall and‘s Lance Zeurline rated him as a Perennial All-Pro.  

Adrian Peterson and Jerick McKinnon provide the best recent available physical metrics, but McKinnon was a QB in college.  So, maybe we should compare RBs to RBs and not athletes to athletes in this case if we’re interested in best comparable players.  Adrian Peterson’s return from ACL repair was unprecedented, but he may just be our best comparison in this category.  

I’ve manually pulled the data for every RB from 2011-2019, and it gives us way too many incomparable RBs.  Here’s an inclusion criteria I made based on what we know from the research with special consideration to Saquon Barkley as our athlete of interest..  

Here’s what we get: 

Graph showing rushing performance of players wiith ACL injuries.

It’s a bit all over the place, but check out the career average line.  It’s virtually the same.  *It should be noted that Knowshon Moreno was benched after fumbling in his 1st year post-op, and Joe Mixon was drafted the year after Gio Bernard’s ACL. Jamaal Charles, Adrian Peterson, Knowshon Moreno (after his fumbling season), and Dalvin Cook all overcame the injury, while Rashaad Penny, Giovani Bernard, and Jerick McKinnon did not.  My best answer to this comes from the research.  The better your stats are before injury, the more easily you’ll overcome it. 

In summary, here’s what we know matters: 

  • Draft pick investment 
  • Pre-operation production levels 
  • Preserving the meniscus 
  • Rehab time 

I’m optimistic.  Saquon Barkley hits all 4 marks.  He carries the highest draft pick premium in this group with elite production pre-operation. Reading between the lines, Saquon’s 5th year option was already picked up this offseason.  That’s a positive indication of the internal discussions between the front office and the medical staff.  Courtland Sutton also hits these marks, but we know that WRs’ performances typically suffer harder than RBs.  

Fantasy take-away: An isolated ACL injury is not a doomsday event, but hitting certain marks gives you way better chances of continuing success post-op.  Saquon meets all the known criteria to maintain production through a normal career arc, although year 1 post-op production expectations should be tempered.  I feel the same about Courtland Sutton, although both my short and long-term expectations for him are tempered.  He may not be the dark horse you’re hoping he is.  

Advice: Saquon is a Buy or Hold. Sutton is a Hold or Sell.  

Find The Next Man Up Injury Podcast squad on Twitter at:

Erik Kreil, DPT, PT, OCS, CSCS – @ff_nighthawk
Next Man Up Podcast Co-host, Dynasty and Injury Writer
Ride or Dynasty

Full reference list: 

  • Monoharan et al. Return to Play Rates in NFL Wide Receivers and Running Backs After ACL Reconstruction. The Orthopaedic Journal of Sports Medicine. 2021. 
  • Yang et al. National Football League Skilled and Unskilled Positions Vary in Opportunity and Yield in Return to Play After an Anterior Cruciate Ligament Injury. The Orthopedic Journal of Sports Medicine. 2017. 
  • Carey et al. Outcomes of anterior cruciate ligament injuries to running backs and wide receivers in the National Football League. The American Journal of Sports Medicine. 2006.  
  • Keefer et al. The sunk-cost fallacy in the National Football League: salary cap value and playing time. J Sports Econom. 2017;18(3): 282-297. 
  • Keller RA et al. Athletic performance at the NFL Scouting Combine after anterior cruciate ligament reconstruction. Am J Sports Med. 2015;43(12): 3022-3026. 
  • Brophy et al. Effect of anterior cruciate ligament reconstruction and meniscectomy on length of career in National Football League athletes: a case con- trol study. Am J Sports Med. 2009;37(11):2102-2107. 

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