I don’t need to tell anyone this, but in fantasy football… running backs matter. Fantasy managers draft running backs high; they will overpay for them and risk it all on the next great “breakout” player. Todd Gurley and Derrius Guice are coveted players to have on a fantasy roster because of the position they play. However, they are being treated very differently heading into the 2020 season. After clearing the Falcons’ physical, Gurley has seamlessly been given the green light by fantasy managers and is slotted as a late-2nd/early-3rd round pick in PPR leagues. On the other hand, Derrius Guice has been unable to get on the football field for any meaningful amount of time and is buried in the back of the 6th round. I understand the excitement for Gurley and the trepidation for Guice. We have all seen Gurley dominate (mostly recently in 2018) and for the most part Guice has hardly played. But if fantasy football has taught me anything, recency bias can be a dangerous thing. As I looked into each of these players’ medical histories, I started to realize that my view of these running backs differed from their current ADP.
Todd Gurley
The Injury History:
During his junior season at the University of Georgia, Gurley suffered a non-contact ACL tear. The recovery from this injury bled into his rookie season with the Rams, resulting in him missing the first two games of the season. Once Gurley returned, he was reliable. He missed one more game in 2015 due to turf toe (unrelated to the ACL), played all of 2016, and was active for all of 2017 besides being a healthy scratch in Week 17. Then 2018 happened. Towards the end of the season, Gurley started to experience knee “discomfort” and sat out Weeks 16-17. This was significant, considering that is usually most leagues’ fantasy football championships (ouch.) During the following offseason, reports surfaced regarding the Rams’ concerns about the state of Gurley’s knee. Gurley’s 2019 season started fine before he strained his quadriceps and missed one game. A quadriceps injury based on Gurley’s past medical history is not something to ignore, as I will explain later.
The Case Against Gurley:
It would appear that Gurley’s knee discomfort is the result of early onset osteoarthritis. The symptoms that Gurley was having in 2018 were likely secondary to inflammation due to osteoarthritis (OA). It’s not uncommon to develop OA following an ACL tear. Studies have shown people who suffer an ACL tear are more likely to develop OA 10 years after their original injury. Although the demographics of these studies are not specific to NFL players, it offers some explanation to why Gurley is having these symptoms four to five years after his ACL rupture. When studying players in the age range of Gurley and with a similar past medical history, we see that the rate of knee OA is high (around 20-30%) [1]. The main issue with OA and knee inflammation is there is no treatment for it. It can be managed but it never truly goes away unless you get a total joint replacement which would effectively end Gurley’s career. This means Gurley can play through the pain as long as he can stand it, but the inflammation will continue to develop and get worse with time and the stresses of football.
Research has also shown that after an ACL tear your knee is never exactly the same. The knee joint is biologically and physiologically altered. Over time this can impair neuromuscular patterns of muscle groups around the knee joint – more specifically the quadriceps [2]. The quadriceps is the muscle that Gurley strained in 2019. Another sign that hints lingering issues for Gurley post-ACL surgery.
Information extracted from IPTC Photo Metadata.
Derrius Guice
The Injury History:
After being selected in the second round by Washington, Derrius Guice got off to a hot start in training camp and was pegged as a “sleeper” heading into the 2018 season. However in his very first preseason game, Guice sustained a contact ACL tear, effectively ending his season before it even got started. It’s important to note that unlike Todd Gurley’s injury, Guice’s ACL tear was not a non-contact ACL tear. His knee buckled when his foot was planted in the ground and a Patriot’s defender collided with the outside of his right leg. Non-contact ACL tears can happen for a variety of reasons, some of which are due to poor biomechanics or even muscular imbalances. They can be avoided if these flaws are corrected. However, contact ACL tears are just a circumstance of chance. They can happen to anyone and are the end result when an external force exerts enough pressure that causes the ACL to give. What followed after Guice’s ACL injury was a heavy stream of bad luck.
First, Guice experienced an infection following his ACL repair (ACLR). I can’t stress how rare this is. In my entire professional career I have not seen one healthy client who experienced an infection following this surgery. When I first heard about this I had to look up the infection occurrence rate post-ACLR. Results show that there is between 0.1-1.2% chance that infections occur with arthroscopic ACLRs [3]. There is no doubt that developing an infection delayed Guice’s recovery. It’s worth pointing out the fact that Washington’s medical staff has had issues before such as Alex Smith’s infection post-surgery and the mishandling of Trent Williams’ tumor is troubling. It could be a coincidence, but so many close together like that is concerning. However, I have no inside information on this subject matter.
In 2019, Guice’s time on the field was short lived. Guice tore his right meniscus in Week 1. I typically avoid players the year following an ACL injury due to multiple factors, but injury to the other leg is typically low. Injury to the other lower extremity is around 3.7% for male athletes [4], another sign of Guice’s misfortune.
When Guice was able to return, the young running back played only four games before he sprained his left MCL (the same leg as the ACL repair). He was placed on IR shortly after.
The Case For Guice:
I know it would appear that I am being selective with their medical histories, making an argument against Gurley but not applying those same principles to Guice. Hear me out. Guice suffered a contact ACL tear which we have established is no fault of his own based on the mechanism of injury. He struggled through the early part of his rehabilitation because of an infection. Once he finally returned to action, he injured his right knee, which based on research has a low probability of happening. It’s unfair to label Guice as injury prone, instead he should be labeled as unlucky. Seriously, Daniel Handler could cast Guice in his book series A Series of Unfortunate Events.
Unlike Gurley, Guice has not shown any signs of knee OA, mainly because he has not played. Guice is also much younger than Gurley (will be 23 by the time the NFL season starts) and his ACL tear was more recent. Both of these signs suggest his risk of developing any complications following his ACLR are further down the line. Guice is not injury prone and could be in line for serious fantasy production in the short term.
Conclusion
I am hinging a lot of my argument against Todd Gurley on the belief that he is showing signs of arthritis in his knees. From my point of view the writing is on the walls. It is well documented at this point that Gurley is struggling with knee discomfort in his surgically repaired knee. 2019 also hinted at a possible production decline for the Falcons RB. Gurley saw a dip in his rushing attempts per game, targets per game and yielded under 4 yards a carry (YPC) after averaging nearly 5 YPC the two years prior. There are many suggestions for why this happened, but it’s quite possible the Rams witnessed his decline first hand. In fact, despite taking a major hit to their cap, L.A. let Gurley walk this offseason. You cannot make direct comparisons, but a similar trend happened to Jay Ajayi during his age 26 season. Ajayi also struggled with arthritis after multiple ACL injuries and his fantasy production fell off a cliff. Entering the 2020 season, Gurley will be 26 years old, past the age apex for running back fantasy football production (24) and on the brink of a steeper drop-off. Combine the signs and symptoms of knee OA with his production diminishing, and prepare for him to hit a wall. The argument I often read for Gurley is that he signed a short contract with Atlanta and they are going to “run him into the ground.” Doing such might result in him being unable to finish the season again. I don’t want to be anywhere near it when that floor breaks, especially when the discussed player is being drafted in the second round.
Derrius Guice on the other hand will be 23 by the time the 2020 NFL season starts, below the aforementioned age apex. Guice has not shown any complications of his ACL tear yet, admittedly because he has not played much. I could be making the same argument that I made for Gurley against Guice in 2-3 years, however until he shows signs of slowing down or decreased production I won’t do it. I don’t think the fantasy community is being fair to Guice. When I look at his situation, it’s evident to me that his injury history is the result of poor luck opposed to being injury prone. Don’t misunderstand me either. There is risk with Guice, but it’s a risk worth taking in the middle rounds of fantasy drafts. Running backs of Guice’s caliber do not make it to the 6th round of fantasy football drafts. If I am going to take a chance, it is going to be on the player who is young, misunderstood, and carries the least amount of risk based on ADP. Guice has all the makings of a league winner heading into 2020.
For More information regarding Todd Gurley and the Atlanta Falcons’ offense, check out another piece on our site called “Atlanta Falcons Offseason Breakdown” by Vivek Iyer.
References:
[1] Golightly, Y. M., Marshall, S. W., Callahan, L. F., & Kevin Guskiewicz, K. (n.d.). Early-Onset Arthritis in Retired National Football League Players. Retrieved June 30, 2020, fromhttps://www.researchgate.net/publication/40428176_Early-Onset_Arthritis_in_Retired_National_Football_League_Players
[2] Schmitt, L., Paterno, M., Ford, K., Myer, G., & Hewett, T. (2015, July). Strength Asymmetry and Landing Mechanics at Return to Sport after Anterior Cruciate Ligament Reconstruction. Retrieved June 30, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4418954/
[3] Gupta, R., Sood, M., Malhotra, A., Masih, G., Raghav, M., & Khanna, T. (2018). Incidence, Risk Factors, and Management of Infection Following Anterior Cruciate Ligament Reconstruction Surgery. Retrieved June 30, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6055468/
[4]Shelbourne, K., Gray, T., & Haro, M. (2009, February). Incidence of subsequent injury to either knee within 5 years after anterior cruciate ligament reconstruction with patellar tendon autograft. Retrieved June 30, 2020, from https://www.ncbi.nlm.nih.gov/pubmed/19109531
