Latest / The ACL Athlete Podcast / 295 | Two NFL Players, Two Very Different Paths Back From ACL Surgery

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295 | Two NFL Players, Two Very Different Paths Back From ACL Surgery · The ACL Athlete Podcast

• 0:18
  SPEAKER_00: Welcome everyone to the ACL Athlete Podcast.
• 0:22
  SPEAKER_00: This is the podcast where we talk about everything related to the ACL, whether that's the injury itself, the rehab process, return to sport, and more.
• 0:31
  SPEAKER_00: I'm your host, Dr.
• 0:32
  SPEAKER_00: Ravi Patel, performance physical therapist and coach.
• 0:36
  SPEAKER_00: Between myself and fellow guests and experts, you'll learn through the lens of the patient, the healthcare professional, and the coach.
• 0:43
  SPEAKER_00: The goal of this podcast is to equip you, the athlete, with the education to make the best informed decision about your care and your ACL journey.
• 0:54
  SPEAKER_00: Thanks for joining.
• 0:55
  SPEAKER_00: Now let's dive into today's episode.
• 1:00
  SPEAKER_00: What is up, team, and welcome back to another episode on the ACL Athlete Podcast.
• 1:06
  SPEAKER_00: So today we are talking about two NFL athletes with two different recoveries.
• 1:12
  SPEAKER_00: One of them just came back from a torn ACL and torn LCL and played on Monday night in week one.
• 1:20
  SPEAKER_00: The other one is still waiting, and he got absolutely ripped in the comments for it.
• 1:27
  SPEAKER_00: He's absolutely getting blasted by everyone when you think and see when you see anyone who is commenting about his answers or his particular case on social media.
• 1:42
  SPEAKER_00: And it's just very interesting when you just kind of look at this.
• 1:46
  SPEAKER_00: And I know that there's just different context for each person and the way that they answer things, but yeah, this is very interesting.
• 1:54
  SPEAKER_00: So I want to talk about this today.
• 1:56
  SPEAKER_00: Patrick Mahomes and Michael Penix Jr.
• 2:00
  SPEAKER_00: Same injury label for both of them in terms of an ACL injury, but it is not the same injury.
• 2:07
  SPEAKER_00: And that's what this episode is about is that we can't compare one person's recovery to another.
• 2:12
  SPEAKER_00: And I know we have talked about in the past of comparison and recoveries, and I even did an episode recently about comparison, but I think it's really important for us to just talk about this, especially using examples and what we're seeing in the media, because this is what is especially crafting people's perception of this process, and it might be even crafting your own.
• 2:35
  SPEAKER_00: And so this is one where we can't necessarily compare one person to another, and especially not even one pro to another pro, and not you to the athlete you may follow on Instagram or you see in the clinic, or you might see on a forum, who are saying even the same exact injury, let's say you both tore it skiing or playing soccer or whatever it is.
• 3:00
  SPEAKER_00: Let's say it was the same relative timeline in terms of the date.
• 3:03
  SPEAKER_00: And then let's also say, just to make it very similar, that you had the same procedure, same graph type.
• 3:12
  SPEAKER_00: So that helps to just kind of layer in some context there in terms of how this can be so different person to person.
• 3:21
  SPEAKER_00: And what brought this up is that one of the members on my team sent us a video of Michael Pennox, the Atlanta Falcons quarterback, answering a reporter's question about his ACL recovery when he's going to play again.
• 3:37
  SPEAKER_00: And he was asked to compare his timeline to Patrick Mahomes, the Kansas City Chiefs quarterback.
• 3:44
  SPEAKER_00: So then, you know, I was just curious what are people saying?
• 3:48
  SPEAKER_00: And they were absolutely ruthless on Penix, which was just really sad.
• 3:53
  SPEAKER_00: But it highlighted something important the public's perception of an ACL recovery.
• 3:58
  SPEAKER_00: Now, granted, Penix does come with a little bit of a loaded case with his history and whatnot, but there's also people who are like, what kind of decisions are these professional teams making when they draft?
• 4:13
  SPEAKER_00: Which is another topic in and of itself.
• 4:16
  SPEAKER_00: But with that said, it does really highlight when you read some of this stuff, people's perception of ACL recovery.
• 4:23
  SPEAKER_00: Primarily that they are all created the same.
• 4:25
  SPEAKER_00: People assume every ACL recovery the same.
• 4:28
  SPEAKER_00: It's honestly very similar to assuming that every pregnancy and delivery is the same.
• 4:34
  SPEAKER_00: You're trying to think that, okay, yeah, it happens to each person, but I guarantee you, if you talk to any person who has had a kid, multiple children, that their deliveries and recoveries are different.
• 4:45
  SPEAKER_00: And even talking to my wife about our two kids and how that pregnancy and the delivery and everything, it's completely different.
• 4:54
  SPEAKER_00: And so it's really hard to even compare within the same person of you know, whether it's a single ACL tear, two ACL tears, three ACL tears, and then across lining up 10 of you, 20 of you, 100 of you, it's all going to be very, very different.
• 5:11
  SPEAKER_00: But I think that the perception is that they're all created the same.
• 5:15
  SPEAKER_00: That if you know, X athlete came back in six months, that why can't other people do it?
• 5:20
  SPEAKER_00: Or this athlete came back in, you know, nine months.
• 5:24
  SPEAKER_00: And so why can't this person get there?
• 5:26
  SPEAKER_00: Right.
• 5:27
  SPEAKER_00: And so I think people are not considering the factors that layer into these decisions.
• 5:34
  SPEAKER_00: And I'm sure some of you here are also nodding your head of like, yeah, it's different.
• 5:39
  SPEAKER_00: But it's hard because there's a comparison game, and then especially whenever you tie in people's perception to this, it makes it very, very challenging.
• 5:49
  SPEAKER_00: But the thing is, is like, I get why.
• 5:51
  SPEAKER_00: Because if you're not in this world, what do you hear?
• 5:53
  SPEAKER_00: You hear, you know, the pro athlete, you hear nine months, especially that is being thrown around, or 12 months.
• 6:01
  SPEAKER_00: Every headline says probably around nine months now, which is better than it was.
• 6:05
  SPEAKER_00: It used to be six months, but now we have shifted to hear a bit more of nine months, which is better again, but that is the floor, that's the bare minimum.
• 6:17
  SPEAKER_00: So when people are like, oh, well, nine months and they're barely there, they're like, Well, yeah, but that is a proxy of potentially the floor of where you would be.
• 6:27
  SPEAKER_00: And you know, one surgeon said on the record that a high performing athlete returning in nine months or sooner wouldn't be unusual, right?
• 6:36
  SPEAKER_00: So that's something that we see a lot, especially in the surgical community.
• 6:41
  SPEAKER_00: And it's enticing whenever someone might be like, Oh, well, you can come back in six months, or you can come back, yeah, I'll get you there in nine months.
• 6:48
  SPEAKER_00: And that can happen.
• 6:49
  SPEAKER_00: Yes, we have plenty of people who do that, and that can be the case, but it often can be this thing of maybe a marketing or like, yeah, I can make it happen.
• 7:01
  SPEAKER_00: And yeah, if someone's in a very tight timeline, depending on different contexts, then yeah, maybe it can be done.
• 7:07
  SPEAKER_00: But I would say that a lot of times people are going to be hitting that nine-month, if not longer, towards the 12-month range.
• 7:15
  SPEAKER_00: And again, graph type and all these other life things and factors are gonna factor into that.
• 7:20
  SPEAKER_00: But in reality, what we're looking at is we're comparing apples to oranges context-wise.
• 7:26
  SPEAKER_00: And uh a quick note before we go further.
• 7:30
  SPEAKER_00: I'm not, you know, involved with Michael Pennox's case, not Patrick Mahomes' case.
• 7:36
  SPEAKER_00: I don't have their charts, I don't know the backgrounds in detail, so I'm not gonna sit here and act like I know everything about their cases, but everything I'm about to say comes from what has been reported publicly and what Michael himself has said.
• 7:51
  SPEAKER_00: And so just to give you some background here, Patrick Mahomes tore his ACL and LCL on December 14th, 2025.
• 7:59
  SPEAKER_00: Surgery was the next day.
• 8:02
  SPEAKER_00: Yeah, he had it the next day, and with a lot of pro athletes because they can't, you know, just take time to prehab unless there is a very specific situation where they have to, you're gonna see them go immediately into surgery because they need to get back to playing as soon as they can.
• 8:18
  SPEAKER_00: He was back Monday night of this past week, week one, September 14th of the NFL season.
• 8:25
  SPEAKER_00: That is just about nine months.
• 8:28
  SPEAKER_00: If you really look at it, it's right under nine months, like eight months and I believe like 29 or 30 days.
• 8:35
  SPEAKER_00: But with that said, let's just round it up to nine months from the tear.
• 8:39
  SPEAKER_00: And the thing that I want to just kind of be clear here is that like he it's not that he's rushing, right?
• 8:45
  SPEAKER_00: I mean, there could be this like Patrick Mahomes side of things where he's like, Yeah, I'm rushing into this because I need to prove you know who I am.
• 8:54
  SPEAKER_00: But nine months, you know, is a fair benchmark, and the research points to the value of it, and you know, even the preseason, he wasn't like highly involved like he normally would.
• 9:04
  SPEAKER_00: So there is some merit to that.
• 9:07
  SPEAKER_00: And you know, he's working with performance staff, he's working with people who are hopefully testing the right things, I would imagine.
• 9:15
  SPEAKER_00: He's working with medical staff, he's also thinking about the long term to some degree, but he's also wanting to be out there because he's a competitor, right?
• 9:22
  SPEAKER_00: And this is his first ACL.
• 9:25
  SPEAKER_00: And the other thing I do want to just kind of side note, mention is that it's not like nine months is a magical timeline of like, hey, like you're bulletproof from re-injury.
• 9:36
  SPEAKER_00: It's just an intersection of where biological healing we know can get to the point of where the ACL can replicate what the native ACL was, the tension of it and do its job from a healing and ligamentization and biology standpoint.
• 9:54
  SPEAKER_00: The other side of this is that it takes time to rebuild that knee and the body and athleticism, and usually it's a good proxy of at least needing nine months.
• 10:04
  SPEAKER_00: That said, Aspetar put out a study that showed that nine months is not necessarily a must.
• 10:10
  SPEAKER_00: It's more so of like, do you hit the proper criteria?
• 10:14
  SPEAKER_00: And I also stand by this.
• 10:15
  SPEAKER_00: We have people who go back to doing before nine months.
• 10:19
  SPEAKER_00: Do we educate them on the risk and the research?
• 10:22
  SPEAKER_00: Sure.
• 10:22
  SPEAKER_00: But at the same time, we're also going to let them know, especially if they're crushing their criteria.
• 10:28
  SPEAKER_00: Now we're not gonna let them out there at four months, and rarely is someone ever doing that.
• 10:32
  SPEAKER_00: But people might be in the seven or eight month mark.
• 10:35
  SPEAKER_00: They have high stakes, and you know what?
• 10:38
  SPEAKER_00: They're crushing the criteria, and there might be situations where it makes sense, right?
• 10:43
  SPEAKER_00: But this is where we're still gonna try and find the intersection of that.
• 10:46
  SPEAKER_00: So that's Patrick Mahomes.
• 10:48
  SPEAKER_00: Michael panics towards ACL, his left one on November 16th.
• 10:52
  SPEAKER_00: Surgery was November 25th, around Thanksgiving.
• 10:55
  SPEAKER_00: This is his third ACL surgery.
• 10:58
  SPEAKER_00: The first two were on his right knee at Indiana 2018 and 2020.
• 11:03
  SPEAKER_00: This time, surgeons used a quad graft and an added LET or a lateral rotational stability procedure.
• 11:11
  SPEAKER_00: It's called a lateral extraarticular tenodesis.
• 11:15
  SPEAKER_00: This is helping for re injury risk that we're seeing on more and more athletes.
• 11:21
  SPEAKER_00: But this was also added to his procedure.
• 11:23
  SPEAKER_00: So this is the same NFL league, the same season, you know, in theory, the same, you know, label of having an ACL surgery.
• 11:31
  SPEAKER_00: And that gets the show.
• 11:32
  SPEAKER_00: It's not like, oh, ACL quad graph press L E T.
• 11:36
  SPEAKER_00: They're like, he had ACL surgery.
• 11:37
  SPEAKER_00: That's what you see on the headlines.
• 11:39
  SPEAKER_00: So you have to understand totally different situations.
• 11:43
  SPEAKER_00: And I don't necessarily want to explain what he said.
• 11:46
  SPEAKER_00: I want you to hear it because we don't hear this from a professional very often.
• 11:51
  SPEAKER_00: And I'm gonna read it word for word and then tell you what I hear.
• 11:55
  SPEAKER_00: When he was asked about Patrick Mahomes and, you know, his injury and coming back to play and hit comparing Michael Penix Jr., Michael Penix Jr.
• 12:05
  SPEAKER_00: said, not all injuries are the same.
• 12:09
  SPEAKER_00: And just because Patrick Mahomes had ACL surgery, he didn't get the same procedure as me.
• 12:16
  SPEAKER_00: He had his patellar tendons, he was able to use those graphs.
• 12:20
  SPEAKER_00: I had to use a quad graph because I used both of my patellar tendon graphs.
• 12:24
  SPEAKER_00: I also got an operation on my lateral side.
• 12:27
  SPEAKER_00: I got more done to my knee than he got.
• 12:29
  SPEAKER_00: So if you look at me after my first ACL surgery in 2018, I was back in six months.
• 12:36
  SPEAKER_00: Questionable.
• 12:37
  SPEAKER_00: But this is my third.
• 12:40
  SPEAKER_00: I don't have the same tendons and stuff to use for this graph ACL graft.
• 12:45
  SPEAKER_00: Also, I added the lateral LET graph that I got.
• 12:49
  SPEAKER_00: So it's more than Patrick Mahomes tore his ACL and he's playing.
• 12:53
  SPEAKER_00: Why isn't Mike?
• 12:55
  SPEAKER_00: It's two totally different injuries.
• 12:58
  SPEAKER_00: And I just want you to think about what he said.
• 13:02
  SPEAKER_00: A first round quarterback stood at the podium, explained graph choice to the general public.
• 13:07
  SPEAKER_00: Both patellar tendons already used, so they went to the quad.
• 13:12
  SPEAKER_00: A lateral extra-articular tendodesis, LET, added on top of that third surgery.
• 13:19
  SPEAKER_00: Most people hear ACL surgery and picture one operation.
• 13:23
  SPEAKER_00: He just told you it's not.
• 13:25
  SPEAKER_00: And then let me share some more.
• 13:27
  SPEAKER_00: When he mentioned he was close to feeling good enough to play, he mentioned he's got just some goals I want to hit.
• 13:36
  SPEAKER_00: And he was being asked about how he will determine if he's ready to face a live defense.
• 13:43
  SPEAKER_00: And that's what he said.
• 13:44
  SPEAKER_00: I'm gonna keep those particular goals to myself and the training staff, but I'm close.
• 13:50
  SPEAKER_00: Like I said, I'm close.
• 13:52
  SPEAKER_00: I'm working extremely hard.
• 13:53
  SPEAKER_00: I want to be out there, I'm dying to be out there, but at the same time, I've got to think about how I feel and think about things that I need to work on to make sure I hit before I go out there onto that football field.
• 14:08
  SPEAKER_00: And he's protecting things, and I think that's from really important here.
• 14:12
  SPEAKER_00: He's not just giving you a date, he's saying he has goals and he's keeping them between him and his training staff.
• 14:18
  SPEAKER_00: That's those criteria that he needs to hit.
• 14:21
  SPEAKER_00: Not necessarily focus on the calendar, like, hey, by this date, because that's also gonna handcuff him a little bit and be scrutinized even more.
• 14:29
  SPEAKER_00: And I appreciate this answer because he's giving it more of a range and flexibility, but he's giving some sort of update of like, okay, I'm feeling close.
• 14:38
  SPEAKER_00: The thing is, most people get cleared by time and not by this readiness or performance criteria.
• 14:44
  SPEAKER_00: And he's really leaning into the opposite of that, especially with what's what's on the line here.
• 14:50
  SPEAKER_00: And then the last thing I'll share here is what he said.
• 14:52
  SPEAKER_00: I'm working each and every day, and right now I've got to be where my feet are.
• 14:57
  SPEAKER_00: Today I felt good in practice.
• 14:58
  SPEAKER_00: I want to keep making strides, keep feeling better each and every day, and that's what it's about.
• 15:03
  SPEAKER_00: And once my knee feels where I need it to be, I'm gonna be ready to play.
• 15:07
  SPEAKER_00: Like I said, there's no number on it, no week three, week four.
• 15:12
  SPEAKER_00: Whenever my knee feels good, I'm going to be out there.
• 15:16
  SPEAKER_00: And people assume a guy with this history who waits, he must be scared, right?
• 15:21
  SPEAKER_00: Like he's just not wanting to get out there.
• 15:23
  SPEAKER_00: He said no, it's not mental.
• 15:25
  SPEAKER_00: He wants to go play, like that's important to him.
• 15:28
  SPEAKER_00: He won't go out there if he doesn't feel like where he needs to be physically.
• 15:33
  SPEAKER_00: Waiting isn't fear, it's a decision.
• 15:37
  SPEAKER_00: And so I think this is really important in this, and I want every ACL or listening to hear that from someone with that much on the line.
• 15:45
  SPEAKER_00: And just two more names that I want to share because this is what waiting looks like at the top of the league.
• 15:52
  SPEAKER_00: Nick Bosa for the 49ers tour as ACL September 21st, his second one as a pro in terms of the opposite knee from 2020.
• 16:04
  SPEAKER_00: His first game back was week one this year in Melbourne, 354 days later.
• 16:10
  SPEAKER_00: And I do understand that there's seasonal changes, so then therefore, people have more time available because if you do it earlier in the NFL season, the season's over, you have more time.
• 16:20
  SPEAKER_00: So I do want to factor that in that maybe because of the timing of the start of the next season, they had more time, anyways.
• 16:27
  SPEAKER_00: Had there been closer times between the injury and the start of the season, would they have come back faster?
• 16:33
  SPEAKER_00: Maybe.
• 16:34
  SPEAKER_00: But I would also argue no, because these athletes are still taking their time trying to hit the right metrics.
• 16:40
  SPEAKER_00: But this time he did take it slower compared to previous because he dealt with bumps he didn't need to in terms of the first process.
• 16:50
  SPEAKER_00: And then with Malik Neighbors, this being the other person, he tore his ACL and meniscus September 28th, waited a month for surgery to let the swelling settle, played his first game back last Sunday night, 350 days after the tear.
• 17:05
  SPEAKER_00: He said he wasn't going to put his career at risk by coming back too soon, and he didn't know he was playing until about two hours before kickoff.
• 17:14
  SPEAKER_00: That was kind of the decision that he made.
• 17:16
  SPEAKER_00: Of course, they in reality made that decision probably before internally, but they made that decision in terms of if he was playing on the roster then.
• 17:25
  SPEAKER_00: And they still held him to 36 of you know, 68 snaps.
• 17:31
  SPEAKER_00: That's four players.
• 17:32
  SPEAKER_00: I'm not claiming a role, you know, but the honest range is roughly nine months to almost a year.
• 17:38
  SPEAKER_00: And Mahomes is on the fast end of it, not Penix, he's taking his time.
• 17:43
  SPEAKER_00: And here's where I think the comparison really breaks.
• 17:46
  SPEAKER_00: Just some context here.
• 17:48
  SPEAKER_00: In my opinion, Michael Penix has one chance when we really look at it.
• 17:52
  SPEAKER_00: Patrick Mahomes could re-injure the knee or the other side and still rehab and play again, and he would.
• 17:58
  SPEAKER_00: If it happens to Penix, it would be his fourth ACL tear.
• 18:02
  SPEAKER_00: My gut says that there's a 99% chance he's done with football after that.
• 18:07
  SPEAKER_00: Personally, I think he'd try, but I don't think another team would take that on.
• 18:12
  SPEAKER_00: And that's my read.
• 18:13
  SPEAKER_00: It's not a fact, but you know, they have to also assess like, is this worth it for the money and for the trajectory of this?
• 18:20
  SPEAKER_00: Right.
• 18:21
  SPEAKER_00: Then look at what's on the line.
• 18:23
  SPEAKER_00: Mahomes is already set for life financially, and especially endorsements.
• 18:28
  SPEAKER_00: His also just career so far has been very successful.
• 18:32
  SPEAKER_00: Michael Penix Jr.
• 18:34
  SPEAKER_00: has a lot more on the line, health-wise, financially, lifestyle-wise.
• 18:38
  SPEAKER_00: And he's a quarterback on a team with all four quarterbacks in the mix this week.
• 18:43
  SPEAKER_00: So waiting isn't just free for him.
• 18:45
  SPEAKER_00: Like he kind of needs to get going, but he's still choosing to wait.
• 18:48
  SPEAKER_00: So pro athletes are in these challenging positions with all the money and the best resources possible, and it's their full-time job.
• 18:55
  SPEAKER_00: And they're still taking time returning back to play.
• 18:59
  SPEAKER_00: Some of you are, you know, in your teens.
• 19:02
  SPEAKER_00: You might be in college, you are in your later 20s, 30s, 40s, 50s, 60s.
• 19:09
  SPEAKER_00: Yes.
• 19:09
  SPEAKER_00: Everyone of you listening, you have such a range of ages that we have on our roster, and that people are going through this.
• 19:17
  SPEAKER_00: And there are people that are telling themselves, I need to do this in six months, I need to do this in nine months.
• 19:24
  SPEAKER_00: And the thing is, y'all, is that it's just not ideal to just put ourselves in these like very challenging positions of a time constraint.
• 19:33
  SPEAKER_00: And unless you have these massive things on the line, we really have to consider what is going on and what's at risk.
• 19:39
  SPEAKER_00: And I'll ask it this way: why rush and risk this unless there is something so important at stake?
• 19:46
  SPEAKER_00: I would argue these guys have the most at stake.
• 19:49
  SPEAKER_00: Michael Penix has the most of all, more than the majority of people.
• 19:54
  SPEAKER_00: And they're still taking their time.
• 19:56
  SPEAKER_00: They want to come back at a high level, but they also want to make sure this doesn't happen again.
• 20:00
  SPEAKER_00: And one thing to just share is that Grindham and colleagues showed that, you know, when they followed 106 athletes pivoting sports for two years after ACL reconstruction, going back to level one, that reinjury rate dropped by half for each month return was delayed, up to nine months.
• 20:18
  SPEAKER_00: And 38% of athletes who failed their return criteria were re-injured versus under 6% of those who passed.
• 20:25
  SPEAKER_00: Again, it's something that really helps in terms of really setting the bar of time and making sure we wait, but more importantly, hitting the criteria and not just focusing on time in the calendar.
• 20:37
  SPEAKER_00: So three things to take with you ask what are my current criteria to return, not when can I return?
• 20:44
  SPEAKER_00: Don't compare your timeline to anyone's, including your pros.
• 20:48
  SPEAKER_00: Write down your context, graft other structures involved, prior injury, sport, position, and what's at stake, and just your life.
• 20:55
  SPEAKER_00: That helps to just be able to recognize that yours is different from the other 50 quad graphs you read across or the other people who are your age, right?
• 21:05
  SPEAKER_00: That is very important.
• 21:07
  SPEAKER_00: Make sure to do it right, don't rush it.
• 21:10
  SPEAKER_00: Play the long game, block out all the noise and the pressure as much as you can because we can't compare one person's recovery to another.
• 21:19
  SPEAKER_00: That's gonna do it for today, y'all.
• 21:20
  SPEAKER_00: I just want to share this.
• 21:21
  SPEAKER_00: I think it was really important to just highlight these professional athletes that we hear about, and also someone saying something that I think is very important to register across a lot of people who are in this space because it's good to hear this from people in the professional setting to be able to say these things and to be able to help anchor this, especially with what's at stake for them.
• 21:45
  SPEAKER_00: So I hope this helps.
• 21:47
  SPEAKER_00: If you have any questions, please reach out.
• 21:49
  SPEAKER_00: Otherwise, I will see you in the next episode.
• 21:51
  SPEAKER_00: This is your host, Ravi Patel, signing off.