I have said many times that the team usually knows before an MRI whether a player has suffered a torn ACL.

In my 17 years as a head team physician, in fact, we always knew before we left the field based on careful physical examination.

So how did Falcons safety Keanu Neal suffer an ACL tear in Thursday’s season opener and the team not know until Friday?

Maybe the Falcons did know. Or maybe they were too reliant on an MRI and not their own medical experience.


Neal went down after a misstep in the second quarter, was checked by the team medical staff and returned to the game in the third quarter.A half-dozen plays into the second half, he went down again. This time, he did not return.

After the game, Falcons head coach Dan Quinn said the injury “doesn’t appear serious,” and it was reported Neal would get a precautionary MRI.

On Friday came word of a season-ending ACL tear.

The sequence of events is odd.


The Lachman test, properly performed, is highly accurate. And there is no doubt teams usually are hedging by saying an MRI is pending, as they usually know what to expect.

I personally experienced one occasion in which a general manager told the player, public relations department and medical staff to keep an ACL tear secret so he could execute a trade before the announcement the next day.

As for how it came down with the Falcons, let’s consider the possibilities.

Perhaps the truth about ACL tear (or at least suspicion of one) was known and the team didn’t let on for competitive reasons, which might have included attempting to make a roster move. Perhaps the team knew, and Quinn was just expressing a sort of hope against hope. Perhaps they didn’t want to alarm the fan base until news was definitive.


I maintain that a knee (especially acutely injured ACL) is almost never too sore to examine, especially before swelling sets in. That is the advantage to examining players on the field or immediately in the locker room.

A gentile Lachman exam where the doctor pulls on the tibia to see the translation from the femur is as accurate – and sometimes more accurate – than an MRI. An MRI can read partial tears when the ACL is completely torn.

Now, it is important to note Neal returned to the game.

Perhaps the two injuries were unrelated.


It is possible the knee appeared stable via an exam with a partial ACL tear and only after the second injury was the knee detectably unstable. (This rarely happens.)

The worry is Neal possibly did additional damage to the knee by continuing to play on it.

It is possible to play and even be effective on certain plays because an ACL is mainly needed to provide cutting stability. Players can run straight ahead without an ACL, which is why they sometimes walk off the field without a limp even after a tear.

In this case, if Neal’s ACL was torn after the first incident, he proved one can play football without an ACL. However, to do so is playing Russian roulette. You may get away with it for a few plays, but it catches up to you.


Neal had already returned to play before I had a chance to review video of his first injury. When I did review the play, there was only an end zone view. And although suspicion of an ACL tear existed, I could not conclude by our 95 percent standard to say so.

With the latest @SNFonNBC replay (can't be certain as only one angle), but there is worry for ACL injury on #KeanuNeal @Falcons. Anyone got another video view? Hope not true. — David J. Chao, MD (@ProFootballDoc) September 7, 2018

On the second injury, I felt there was sufficient evidence despite once again only one replay angle to fear ACL tear.

Unfortunately, the postgame press conference provided false hope.


Even if this seems odd in the way the team seemed surprised by what should have been a clear-cut situation, there is probably an explanation.

The actual series of events may never come to light. But they usually do, and it usually makes sense in the end.