Top receivers Julian Edelman and Cameron Meredith went down this weekend, bringing the total number of confirmed NFL players felled by ACL tears to 23 since the start of training camp.

Many are calling it an epidemic.

Is that the case? Or is the label overdramatizing the rash of ACL injuries to top players?

It is more the latter.


The 23 ACL tears – with one week of preseason to go – is higher than last year but just the third-highest among the past five preseason/training camp periods. According to ACL Recovery Club, there were 26 ACL tears in 2015 and 31 in ‘13.

(Including one suffered in OTAs and one in an offseason workout prior to OTAs, there have been 25 reported ACL tears requiring surgery incurred at NFL facilities in 2017.)

Of the 32 teams, 19 have had at least one player suffer an ACL injury since the start of training camp. The Dolphins, Patriots, 49ers and Seahawks have all lost two players to ACL reconstruction since the start of camp. The typical season-long average is approximately 1.5 ACL tear per team per year.

That number will remain steady or perhaps even increase.


The concussion issue has taken the forefront, but the ACL issue has always been around and will continue to plague NFL players. While the NFL works to improve head safety, there is little that can be done to prevent ACL injuries among these elite athletes.

Eliminating all preseason games would not be the answer. As many – or more – ACL injuries happen in practice as in games. By our count, of the 23 players to have suffered ACL tears since the start of camp, 13 were in a practice and 10 were in games.

Players do need some preseason game action in order to re-acclimate after a lengthy time off. (We have proposed a solution for shortening the preseason to three games and adding a second bye week to improve health, increase revenue and solve the short rest problem inherent with Thursday night games.)

About half of ACL tears among NFL players occur in the preseason. But this does not mean that preseason is more dangerous than the regular season or that its elimination would reduce tears. Remember, there are 90 players on the roster during the preseason as opposed to 53 during the regular season. That actually affirms that ACL tears are less pervasive in the preseason.


Some have suggested ACL prevention programs could be instituted with jump and landing training. But those work best on the untrained athlete and females, and they have not been proven effective in the NFL. And actually, in the course of their regular workouts NFL athletes already perform much of the muscle training included in prevention programs.

Offensive linemen and some defensive linemen are mandated to wear knee braces in in college. But for the most part, that is not the case in the NFL. Many athletes resist wearing braces in the NFL, as they feel it restricts them. Modern brace technology is excellent, and as an orthopedist, I recommend prophylactic knee brace usage. But I do not play football and players value performance and technique over bracing that feels restrictive to them.

And the fact is, while use of knee braces can help, it does not prevent all ACL tears.

So why have ACL tears not declined with decreased practices and contact mandated in the current CBA, which was agreed upon prior to the 2011 season?


The answer is that the vast majority of ACL tears are non-contact injuries. Eliminating contact practices does not help. In addition, with the practice limited, practices in today’s NFL are conducted at a higher tempo. High-speed cutting is where the ACL is most vulnerable.

Another big factor is that while athletes get bigger, faster and stronger, the girth of the ACL remains the same. It is like planting a bigger tree in the same size pot. Something has to give.

So are athletes too big, fast and strong?

Certainly, better nutrition and training have produced a new generation of players that inevitably stress the ACL to the max.


An additional potential factor in the abundance of ACL tears is the use of artificial surfaces. The better the footing, the higher risk for ACL tear. For example, games in wet weather rarely have ACL tears. Think of it this way: the point of a ski binding is to have the boot release when the ski is stuck in the snow to prevent ACL tears. Beginners want the binding loose and Olympians crank the bindings tight for better performance but take the risk of injury.

The old-style Astroturf surface was notorious for ligament tears. The new sport grass is better, but still not quite as good as natural grass, which has the most give.

For all that — with the increase in strength, size and speed — even if NFL had all natural grass fields, mandatory prevention exercises, mandated knee braces and eliminated the preseason, the majority of ACL tears would continue.