How quickly can Utah’s Cam Rising get back to 100%? Here’s what researchers say about QBs and ACLs.

The Utes quarterback hopes to be back on the field for the team’s season-opener after tearing his ACL in January.

(Hunter Dyke | Utah Athletics) Quarterback Cam Rising participates in the first day of Utah football fall camp in Salt Lake City on Monday, July 31, 2023.

How quickly is it fair to expect a quarterback to return from an ACL injury?

And, perhaps just as importantly from a University of Utah perspective: how well do they play when they return?

Those are perhaps the two biggest looming questions on this upcoming Utes season — the Utes look well-positioned if Cam Rising can make a triumphant return after his Rose Bowl ACL tear and play at his best. More offensive questions will loom if Brandon Rose or Nate Johnson take the reigns.

As Utes coach Kyle Whittingham put it this week: “Outside of quarterback, the biggest focus would be quarterback. And quarterback again. I can’t think of anything that’s even close to that right now.”

Luckily, there’s a surprising amount of scholarship on the issue of ACL tears in football players and quarterbacks in particular. Maybe it’s because academics at football schools tend to be fans, too, interested in studying the subject for the benefit of their teams. Regardless of the reason, let’s dig into the research — and look at what Rising and the Utah staff have to say about the issue.

Research on ACL return to play

Football players return from ACL injuries surprisingly infrequently.

A meta-analysis of 17 different studies covering over 1,800 players with ACL tears was done by researchers at Tulane University, covering both NCAA football and NFL players. After suffering an ACL tear, players returned to the football field just 67% of the time. That’s far less than the 78% return-to-play rate in the NBA, or 89% in the NHL.

(Meg Oliphant | Special to The Tribune) Utah quarterback Cameron Rising (7) is escorted off the field after an injury in the third quarter against the Penn State Nittany Lions at Rose Bowl Stadium on Jan. 2, 2023 in Pasadena, California.

But not all ACL tears are the same. One study showed that if a meniscus had to be repaired in isolation or in addition to ACL surgery, it made an NFL athlete’s post-surgery career significantly shorter — but players with ACL surgery alone were relatively unaffected in terms of career length.

Maybe an even bigger difference in a player’s likelihood of return to play is simply how valuable the team considers them to be. Multiple studies showed that NFL players who were drafted in the first four rounds were much more likely to return to the football field after an ACL tear than those drafted later. One researcher found that players who made less than $2 million per year were less likely to stay in the NFL after their ACL tear, while those who made more than that had relatively normal careers after their tears. And quarterbacks, the most valuable players, returned to play over 90% of the time in the NCAA and 92% in the NFL.

Perhaps relatedly, players who suffered their ACL tears in the middle of a season were more likely to return to play than those who suffered them in practice, in the preseason, or the offseason — maybe because those off-field minutes are more likely to go to end-of-roster or practice squad players. (By the way: according to one study, games are roughly 10 times more likely to lead to ACL tears than practices. Unless there’s a scrimmage at that practice; scrimmages are about half as dangerous as a game from an ACL tear point of view.)

ACL tears were about 40% more likely to happen on artificial turf than on grass fields, at practice or in games. That being said, Rising bucked that trend: he tore his knee on the Rose Bowl’s grass field while avoiding injury on the turf fields at Rice Eccles Stadium and at the Spence Eccles Field House indoor practice facility.

Return timelines varied wildly. For those who did return from an ACL tear, the average time was 11.6 months — far slower than Rising’s attempted return on Aug. 31, just eight months after his injury on Jan. 2. “When you look at the timetable, when he is going to be cleared, or projected to be cleared, is coming right down to the wire,” Whittingham said.

(Trent Nelson | The Salt Lake Tribune) Cam Rising in the stands as Utah hosts Princeton, NCAA basketball in Salt Lake City on Sunday, March 19, 2023.

“We certainly don’t want to put him out there prematurely or before he’s ready. Which I’m sure [the medical staff] won’t do. ... I’ve got all the confidence in the world in Cam,” the coach continued. “But that’s not our call. That’s between Cam and the medical staff to determine when he’s ready.”

Doctors don’t necessarily find an eight-month injury recovery time problematic. According to a survey of 137 NCAA and NFL team orthopedic doctors, 56% said they would potentially clear a player to return to play at just six months after a tear. Only 12.4% (17/137) said they would choose not to clear a player in less than nine months.

And offensive coordinator Andy Ludwig indicated that Rising is already doing significant work on the field. The QB has been throwing for several weeks, Ludwig said, and Rising is expected to be able to fully participate in practice at some point during fall camp.

“He will be very limited this first week,” Ludwig noted. “We will get a feel for where he is health-wise. But he is cleared to move and throw and drop. So he is going to get some work there. We are just really going to limit team type of plays where he has to have sudden reactions. But he is going to get a lot of throws early in his camp.”

Rising, meanwhile, said that he wants to do “every single movement there is” before the Aug. 31 opener. “Because come game time you never know what movements you’re going to make,” he said. “(I’m) making sure that whatever situation I’m put in, my body will be ready to go.”

How did players perform once returning from ACL surgery?

Let me introduce you to perhaps my favorite line I’ve found in all of my time looking at scientific research. From a study led by New York doctor Colin J. Burgess, the authors write: “Although it is not yet widely accepted in the medical community, we believe that fantasy football data are a true objective way to measure performance in high-level professional athletes following an injury.” Burgess is spearheading that undoubtedly critical effort.

While it might not reach the stuffy medical community’s lofty standards, Burgess’ look at NFL fantasy football production before and after ACL tears is really interesting for our purposes. They examined NFL players from 1988 to 2017 who suffered ACL tears at the major fantasy scoring positions (quarterback, running back, wide receiver, and tight end) and matched them to control group players who didn’t suffer the same injury.

Burgess’ team found that running back and wide receiver production dropped off significantly and hugely. Even three seasons after a tear, running back statistics were significantly decreased compared to those who never underwent surgery.

But quarterback statistics? They’re a little lower, but not statistically significantly so.

NFL running backs and wide receivers saw statistically significantly lower levels of production after ACL tears, while quarterbacks didn't. (https://www.sciencedirect.com/science/article/pii/S2666061X21001875)

In particular, the only statistically significant differences between the ACL-hampered QBs and those who stayed healthy happened in the first season after a quarterback’s tear. Those recovering QBs had significantly fewer rushing touchdowns, which makes some sense, as they take the safer play and avoid scrambling as frequently. But they also recorded fewer interceptions — perhaps that reflects some post-surgery caution in a positive way.

Rising was asked if he thinks he’ll approach the game differently in his first year back from surgery. “No, I don’t think so,” he said. “Football is still football. Sometimes stuff happens in football and you get tackled and it is what it is. You roll with it and go on to the next play.”

Even those minor differences found in Burgess’ study, though, disappeared after the first season back.

Other studies have largely confirmed this result. One found no statistically significant difference after ACL surgery for quarterbacks, another found just a 2% difference. And for those considering Rising’s future, another study found no significant differences in quarterbacks entering the NFL Draft with or without ACL tears. Rising’s future career likely won’t be hampered.

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