Derrius Guice, Washington’s rookie running back, tore his ACL during the preseason. Over 90 percent of NFL athletes who tear their ACL are able to return to their previous level of play. In fact, these days, it’s almost assumed that will happen without fail. When that doesn’t occur in a timely fashion, it’s usually due to other associated injuries, such as meniscal tears, injuries to a second ligament, cartilage damage, etc. Some, such as Dalvin Cook, return only to be hampered by hamstring injuries that their previous knee injury probably predisposed them to.
The Complications Guice Faced and Their Ramifications
Nobody ever really wants to talk about the other 5 to 10 percent that don’t make it back to professional athletics. Guice will return to play again, but his ACL reconstruction was unfortunately complicated by an infection. That’s an extremely serious complication that could happen to any surgeon. Guice’s infection was reported to have lasted for two months and required three subsequent arthroscopic knee “washouts” as well as IV antibiotics to cure it. A “washout” is layman’s term for arthroscopic irrigation and debridement, where the knee is arthroscopically flushed with copious amounts (at least 9L) of fluid and any questionable tissue removed using motorized shavers. His infection has reportedly been fully cured.
At the minimum, this slows down his recovery. Normally, an RB would be able to play six to nine months after an uncomplicated ACL reconstruction. However, there is currently no timetable for Guice’s return.
But there are other issues. Nothing causes scar formation like an infection causes scar formation. So Guice’s knee will have more stiffness than normally follows an ACL reconstruction. In addition, his quadriceps muscle, the main power generator for jumping, cutting, and a major contributor to acceleration, will have more scar formation. In addition, the portals (small incisions through which cannulas are placed to perform knee arthroscopy) penetrate the quadriceps muscle, increasing direct damage to it. And this has now happened more than once.
In addition, bacterial infections directly attack joint cartilage. While I have no doubt that Guice’s infection was expertly treated in a timely and appropriately aggressive fashion, the fact remains that his cartilage was exposed to bacterial infection. This leads to some degree of damage and softening. Considering the stresses that NFL running backs place on their knee cartilage, this may predispose him to future activity-related swelling and aching, potentially leading to decreased practice and/or playing time. It will also decrease the longevity of his career, as his knee’s cartilage will not hold up to those stresses as well as it otherwise would have.
Guice’s Reality and Fantasy Future
Guice was a late second-round NFL draft pick who would have probably been a first-round pick if not for “character concerns.” He was projected to be a significantly above average, potentially excellent, NFL running back. I have no doubt he’ll play next season, but it’s unlikely now that he will ever be quite as good as he would have been. Because of decreased knee flexibility, as well as slightly less quadriceps power for jumping, cutting, and acceleration, he’ll probably be simply an above-average running back, ie. “one notch below” whatever he would have been. And probably with lesser career longevity.