Under normal circumstances, Ronald Acuna Jr. of the Atlanta Braves would be a first-round lock in fantasy baseball drafts. However, circumstances are far from normal as the outfielder won’t be playing any spring training games this season as he slowly attempts a return to the field following last season’s serious injury.
Concern over how long it might be before Acuna is able to once again become a fixture in the Braves lineup has certainly had its impact in fantasy drafts. Currently, Acuna has an ESPN ADP of 37.8 (4th round) and that reflects an improvement of six spots over where he was being taken just one week ago. But is there any good reason for this increased optimism? Let’s take a closer look.
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Acuna’s 2021 season ended abruptly on July 10 when he landed awkwardly after trying to make a leaping play on a ball hit to deep right field. Just steps away from the outfield wall, he decelerated sharply upon landing and the shear translational force of his tibia (shinbone) relative to his femur (thigh bone) resulted in a torn right ACL. He collapsed to the wall and fell to the ground, holding his right leg. Acuna was carted off the field, visibly distraught as the remainder of his 2021 season evaporated.
On July 21, 2021 Acuna underwent ACL reconstruction surgery with Dr. Neal ElAttrache of the Kerlan-Jobe Clinic in Los Angeles. He remained in Los Angeles for the early phase of his recovery, eventually returning to Atlanta to rehab with the Braves.
Unfortunately, as Acuna was approaching a key phase of rehab incorporating more aggressive transition-to-baseball work, the lockout began. An oft-overlooked consequence of the lockout was the inability for players recovering from injury to access their rehab facility and staff. While they could still communicate with their physicians and surgeons, they were cut off from the physical therapists, athletic trainers, strength and conditioning and performance personnel who otherwise would be a part of their total recovery and return-to-play program. For a player like Acuna in the midst of recovering from a major surgery typically requiring nine months to a year of rehab prior to receiving clearance to return to sport, the timing was certainly not ideal.
Left to their own devices, players were forced to find alternate rehab and training facilities and, in Acuna’s case, a means by which to progress back towards higher-level sport-specific activity. For instance, activities such as running and sprinting, agility training, turns, sharp starting and stopping are all elements of post-ACL recovery for a hitter. Considering base stealing is an important aspect of Acuna’s game, the ability to accelerate/decelerate/lead-off, get back/slide all at familiar speed and without hesitation is important.
For outfielders recovering from an ACL injury, a return to defensive play requires additional high-level training. Tracking the ball to make a defensive play requires not only running at high speed (often while changing direction), but also an awareness of the potential hazards in the field of play that may require sudden adjustments. Visual tracking of the running surface often serves as an aid and a confidence builder in the earlier phases of ACL recovery; relying on instinct and trusting the injured leg during multi-directional, speed-variable running while visually tracking an object overhead is perhaps the highest level demand on an ACL-reconstructed knee. This is why outfielders often return to defensive play as the last component of their return to competition.
The ability to initially re-acclimate to game situations while hitting and running not only conditions the athlete for game play, it progressively increases confidence in the surgically-repaired knee. As confidence and trust in the leg continues to build and defensive skills continue to be honed in a controlled practice environment, the outfielder progresses towards the eventual goal of defensive game play in unpredictable situations. Pushing past the fear of re-injury often associated with re-entering phases of sport where the injury first occurred are equally critical for a successful return.
What does the data say?
For all the public familiarity with ACL injuries due to their frequency, it may come as a bit of a surprise that they are relatively rare in baseball. According to a 2022 article by Hartnett et al., “complete ACL tears were uncommon, accounting for only 2% of knee injuries, but resulted in a mean absence from play of 156.2 days, by far the most of all knee injuries.” While the incidence remains low in baseball compared to other knee injuries, the cost for the athlete and the organization in terms of missed time is extremely high.
When ACL injuries do occur, they are most often associated with fielding. A study by Dugas et al.examined 42 baseball players across all levels of competitive play from youth to professional and found the majority of ACL tears occurred during fielding (68%), or base running (29%), with outfielders at the greatest positional risk.
Several relatively recent examples highlight the variance between cases: Pitcher Mariano Rivera tore his ACL while shagging fly balls during batting practice (a pitcher functioning as an outfielder). Pitcher Austin Adams tore his ACL while running to cover first base. Outfielder Kyle Schwarber tore his ACL (along with his LCL and an ankle sprain) while attempting to field a fly ball, but his injury was the result of contact with teammate Dexter Fowler. Both Andrew McCutchen and Adam Eaton tore their ACLs while running the bases, but in very different ways. McCutchen had a sharp deceleration while trying to avoid getting caught in a rundown when his knee buckled while Eaton landed awkwardly on first base trying to beat out the tag and his leg collapsed. The relatively few examples of ACL injury within major-league baseball make it difficult to find comparable injuries to Acuna’s in both mechanism and scope.
The good news is that multiple studies have documented a high level of return to play for baseball players following ACL injury. Dugas reported a 94% return to play rate (at their pre-injury level or higher) following ACL reconstruction.
So where does Acuna stand?
It’s understandable that the Braves would:
Hold him back a bit upon first arrival to allow their personnel to evaluate his status, given the player’s forced absence from the facility due to the lockout.
Begin with him assuming the role of DH. Thanks to the expansion of the DH into the NL’s regular season, the team can extend Acuna’s gradual return to gameplay by starting as hitter/runner only.
Eventually re-introduce him to his role in the outfield as both the team and the player gain confidence in his ability to perform without increased risk.
Even in the days since spring training began, it’s clear the team has been gaining confidence in Acuna’s health as they are able to observe him. GM Alex Anthopoulos originally indicated Acuna would not likely play in the outfield until late May. He later suggested however that he could possibly get outfield starts in early May, based on the feedback he received from the medical and rehab staff.
As is the case with every injury, individual characteristics matter. At just 24 years old, Acuna has youth on his side. He also may have unexpectedly benefited from the delayed start to spring training. After the team facility became off limits due to the lockout, Acuna returned to Los Angeles to the site of his initial post-op rehab, Elite OrthoSport Physical Therapy and Performance.
It’s only fair to allow him the opportunity to work back into his full capacity before comparing a post-ACL reconstruction Acuna to the player he was through the first half of 2021. But, if he indeed returns by the latter part of the season to the explosive, base-stealing, power-hitting player the Braves originally signed, everyone will remember exactly who Acuna is — and fantasy managers who are willing to take the chance on a few potentially bumpy months at the start of the season will be glad they did.