Javonte Williams experienced a catastrophic knee injury in week four against the Las Vegas Raiders. The team’s and fantasy football managers’ fears were confirmed when it was announced he had torn his anterior cruciate ligament (ACL).
The news is worse than that however, as it was later announced he also tore his lateral collateral ligament (LCL) and his posterolateral corner (PLC). These type of injuries are referred to as multi ligament knee injuries (MKLI).
MLKI are especially concerning for athletes. These injuries cause instability in multiple areas of the knee. A loss in stability in one area is cause for concern. A loss of stability in multiple areas is cause for panic.
The ACL works in tandem with the posterior cruciate ligament (PCL) to allow the knee to move back and forth. The ACL is in the front of the knee and the PCL is in the back. The other essential functions of the ACL is to prevent the femur from moving back on the tibia and conversely to prevent the tibia moving forward on the femur. (1)
The LCL runs on the outside of the knee from the top part of the fibula outside of the lower thigh bone. The purpose of the LCL is to keep the outside of the knee stable. (2)
The PLC is crucial to the stability of the knee at angles of less than 45° knee flexion (bending) during weight-bearing. The three most important structures of the PLC includes the popliteus tendon, popliteofibular ligament and fibular collateral ligament. (3) Together these structures along with others that make up the PLC help to stabilise the knee joint against backward and external (outward) rotation forces on the knee. (4)
ACL tears are unfortunately a common injury in sports, especially football, these days. We have seen running backs return to form after an ACL tear and perform well. Adrian Peterson had one of the greatest seasons in NFL history after returning from an ACL tear.
Peterson’s performance was an outlier of epic proportions. ACL tears often result in a lower level of performance post tear. The injury, while prevalent, can be devastating. Coupling that with multiple other tears is even more damning. The inclusion of multiple other tears increases the likelihood that Williams will not return to form for a long time, if ever.
LCL tears are less common than ACL tears. They almost never occur without tearing of other ligaments. Most often they accompany a PLC tear. PLC tears that occur as part of a MLKI almost always require surgery.
MLKI involving the ACL and PLC are the most severe for NFL athletes. A study by Bakshi NK, Khan M, Lee S, et al. titled “Return to play after multiligament knee injuries in National Football League athletes”, (https://pubmed.ncbi.nlm.nih.gov/29638200/) gives us some context for expectations. The study involved 50 NFL players. It determined the return to play rate was 55.6 percent. The return to prior performance level was 18.5 percent.
Another study concerning MLKI in elite athletes, defined as professional or amateur athletes that competed at a national level, gives more reason for concern when PLC tears are involved.
The study came to some conclusions that don’t inspire hope for Javonte. Athletes took an average of seven to 25 months to return to play. The more concerning conclusion is that it takes at least two to three years to return to peak form when these type of injuries occur. (https://journals.sagepub.com/doi/10.1177/2325967120S00366)
This study did not include any NFL players. Of the 109 athletes in the study 38 played rugby, which were the only athletes that played contact sports in the study. The severity of MLKI is often higher because they occur when the knee is hit by another player.
Almost all MLKI involving the LCL and/or PLC involve high velocity impact. The most common ways they happen are in car crashes and high force hits in contact sports. (5)
Running backs play arguably the most punishing position in all of professional sports. This is reflected in them having the highest injury rate of any position in the NFL. Running backs also have the shortest average career length in the league.
In the best of circumstances a running back can expect to play for seven to eight years. Elite production for the best backs can be expected for three to four years.
After his injuries this year Williams finds himself far from the best circumstances. His injuries commonly have lasting negative effects. These effects are felt in many areas.
The stability of the knee has been compromised in several ways.
- Forward and backward movement
- Movement of the femur and tibia
- Movement along the outside of the knee
- Stability of movement when the knee is bent at less than 45 degrees
- Stability to prevent backward movement of the knee joint
- Stability to prevent outward rotation of the knee joint
The ligaments in the knee work in unison to provide stability. They have individual responsibilities but they all depend on each other to provide overall stability. When a ligament is injured it puts more strain on the other ligaments to perform their jobs.
With the tears Williams suffered there will be extra pressure put on his non-injured ligaments. The damaged ligaments will not provide the normal amount of support to the other damaged ligaments. This can increase the recovery time and increase the chance of reinjury.
Even after rehabilitation there will be concerns about hyperextension of the knee, as well as Williams ability to cut and accelerate out of breaks. Almost all running with the foot planted on the ground and cutting is done when the knee is bent at less than 45 degrees. (6) Planting and then cutting puts large amounts of outward pressure on the knee joint.
Many athletes who suffer MLKI also see reduced function in their hamstring and quadriceps on the leg that the injury occurred. (7) The reduction in strength of these areas further reduces the ability to cut and accelerate.
With all of these areas being negatively impacted it is no wonder the return to play rates are low and return to prior performance rates are even lower. Williams will be more affected by the declines in these areas than players at other positions. Running backs’ games are predicated on their ability to accelerate, cut, and juke to make others miss.
The game moves fast and running backs are increasingly seen as replaceable. Two to three years to return to form is a long time for any player, but even more significant for a running back. As we have seen recently when running backs return from injury and have lost a step they are quickly moved out of starting and often out of playing.
After sustaining so much damage to his knee I do not believe Williams will regain the stability needed in it. With a less stable platform to make these aggressive moves I don’t have confidence Williams will be the same player.
- 1. https://www.jeremywoodsonmd.com/blog/what-does-your-acl-do
- 2. https://www.pennmedicine.org/for-patients-and-visitors/patient-information/conditions-treated-a-to-z/lateral-collateral-ligament-lcl-injury
- 3. https://www.spectrumhealthcare.com.au/blog/?post=posterolateral-corner-of-the-knee-plc
- 4. https://www.sportsinjuryclinic.net/sport-injuries/knee-pain/posterior-knee-pain/posterolateral-corner-injury
- 5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7083988/
- 6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4714754/#!po=18.1034
- 7. https://www.jospt.org/doi/pdf/10.2519/jospt.2000.30.7.418
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A fantasy football degenerate with an extreme love for the game. The only position Sam has ever played in any form of competitive football is armchair quarterback.
An affinity for football and watching games together was a part of growing up for him and his three brothers. 30 plus years as a Vikings fan has made him a glutton for punishment and a believer that he can do something his hometown team can’t, put together a championship roster.
Now 22 years into his fantasy football general manager career he is here to offer insight, advice, and the same hope for championships that he desperately clutches to for his Purple People Eaters.
