In a draft class deep in defensive talent, Mississippi State DT Jeffery Simmons stacks up with the best of them. However, during training in February, Simmons tore his ACL in his left knee, putting his entire draft stock and NFL career in jeopardy. While much has been written regarding ACL tears by a variety of sources, including myself, most of these articles have discussed smaller athletes, such as running backs RB Bryce Love and Rodney Anderson. However, these two backs are 5’9” and 200 lbs and 6’0” and 224 lbs, respectively. In comparison, Simmons is a robust 6’4” and 301 lbs. One would have to assume that players of drastically different sizes may heal at different rates. In short, there are questions about someone his size returning to an elite level. There is also worry moving forward both as a draft prospect and future NFL player. Today’s article will focus on his injury, where he is at in his rehab, and how his injury,  recovery, and career may be affected by his size.

What we know about Simmons is limited, which makes this analysis more difficult. However, we do know:

1. Simmons tore his left ACL in early February while performing positional drills
2. Simmons had surgery shortly after the tear and is currently rehabbing
3. There is not video of the drill he was performing. There is also no indication of whether there is any associated damage from the tear, indicating that this may be an isolated ACL injury

As expected, there is concern about whether he will be able to return to the dominant form he had prior to the injury seen in this link. Based on media reporting, he was scheduled to have ACL reconstruction roughly the week of February 17th, which gives us a timeline regarding his rehab. As of the publication of this article, he will be roughly eight weeks out from surgery. According to general rehab protocols, he should be achieving full range of motion in the surgically repaired knee and increasing and beginning to normalize strength in the quadriceps, hamstrings, and hip musculature. He will also be able to begin walking on a flat treadmill, balance training for proprioception, swimming and biking programs, increasing his activity as tolerated. Progress in his rehab is also validated by a recent report in which Simmons released his MRI results at the combine re-checks, which were taken as positive news that the graft is healing correctly.

Body Mass Index

To understand how his size may affect his ability to recover, BMI must also be understood. BMI, or body mass index, is a common and quick way to assess body fat for an individual. The body mass index calculates a person’s height and weight and gives a number that determines if the body mass is underweight, normal, overweight, or obese. Jeffery Simmons’s BMI equated to 36.6, which indicates he is obese. While his BMI score is high compared to a healthy subject of his height with a score of 24.9, he is a muscular, athletic specimen, which alters the interpretation of his results. Like most athletic individuals, Simmons has considerably more muscle than body fat. This affects how BMI is viewed, not solely determining body fat, but overall size. Knowing his BMI score and what it means in his recovery is detailed later.

Thankfully, there is some research available to assess how Simmons will be able to rehabilitate, and it is favorable for his outlook. According to an article in the Orthopedic Journal of Sports Medicine in 2017, research on ACL tears of offensive and defensive linemen in the NFL showed that 88.9% of players were able to return to the sport. There was no difference in production between healthy and injured defensive linemen who returned to play. However, on average, ACL-injured linemen played roughly two fewer seasons than those not injured. Those injured linemen took 11.3 months to return after surgery, which would be outside the window Simmons has in order to play during his rookie season. Importantly, these statistics were taken between 1980-2015, which includes a time period in which ACL reconstruction was in its infancy and outcomes were poor. We have seen ACL outcomes improve dramatically over the past 20 years, which makes it possible that Simmons’s return could be quicker than 11.3 months. This is a promising observation that indicates that Simmons can still play at a high level once cleared.

Knee Morphology

There have been multiple studies demonstrating that BMI is a modifiable risk factor for tearing an ACL, but is not a direct cause for an ACL injury. Listed in the study are also other modifiable factors, including but not limited to weather, footwear, and surface. These are also factors that are currently unknown when assessing Simmons’s specific cause of injury. Getting more specific, there are several studies that show there is a correlation between BMI and ACL tears in relation to knee morphology. One study assessed the width of the femoral notch, which has been shown as a non-modifiable risk factor for ACL tears and its relation to BMI. The femoral notch is the space between the bulbous ends of the femur, where the ACL connects anteriorly. Research has shown that a narrow femoral notch can predispose an individual to a higher chance of ACL rupture.

In another study, researchers assessed the slope and height of various structures within the knee in an attempt to determine risk factors contributing to ACL tears. A variety of structures were measured on MRI scans of those with ACL tears compared to those without ACL tears. They found that the posterior tibial slope and medial cartilage slope demonstrated a higher-degree angle in injured subjects compared to control subjects. A correlation was then established that the higher angle of these structures was associated with increased risk of experiencing a tear. What this means is that when the axial compressive force of pivoting and rotational force is applied, which is one of the mechanisms of injury for an ACL, how well do these structures assist in preventing an ACL rupture? Simply put, he may have had a greater predisposition to tear based on how his knee is structured if he had one of these risk factors present. Reliable testing may be implemented in the future to identify knee morphology risks and ways to reduce the incidence of injury in the general or athletic population, but they are not widely present at this time.

Concurrent Injuries

Other concerns associated with an elevated BMI include the occurrence of concurrent injury to other structures in the knee, such as MCL, meniscus, patella, tibia, etc. Specific predictors for height, weight, and BMI were compared against known ACL tears. The bigger someone is, the greater the possibility that there is associated damage to other structures if suffering an ACL injury. We do not know specifics outside of what Simmons told the media, so this part is all speculative. As an example, if he tore part of his meniscus, that could slow down his rehab because there is more damage, which could lengthen his recovery time and eventual return to the field. We have already seen multiple instances in the decline in production the year after injury from NFL players suffering ACL tears. They often return to baseline performance two or three years after injury.

Risk of Re-injury and Draft Status

What we do know is that even though Simmons should be able to come back, the risk to tear an ACL is greater because he’s under the age of 25, there’s a greater chance he suffers another ACL tear to the opposite side, and his overall chances of suffering another injury are greatest within two years of the original injury. Any way you slice it, Simmons is still a health risk come draft night. Any team drafting him will be looking for long term production, possibly using his rookie year as a redshirt. He could potentially play in 2019, but it would most likely be in the last quarter of the regular season.

Due to the ACL tear, his draft stock may drop considering the depth at defensive tackle available in the first round. He could possibly fall to the second round if teams at the back end of the first round have more pressing needs. A very successful career can still be had, but it may be shortened due to future injury or degenerative changes, such as arthritis. He may benefit from being drafted to a team with an established defense in which he can learn the first year, eventually working into a rotational role. Reading scouting reports regarding his career prospects, he may have several elite years, but I believe he would most likely not be a player that is the foundation of a defense for a decade. It will be interesting to see how far Simmons falls on draft night.

Once drafted and come training camp, he will be roughly six months out from surgery, starting the season on the PUP list. This will allow the team to get him ready while not sacrificing a roster spot. He may not be cleared to play until late November/December at the earliest, more likely missing all of 2019. Simmons appears to be an incredibly talented prospect with an ill-timed injury that may affect him financially. To me, he is a high risk, high reward draft pick. A reward such as that may be too tempting for some high-drafting GMs looking to keep their jobs.

Thank you to Cover 1 for allowing me to provide injury analysis on upcoming draft prospects prior to the draft. If you like what you read, make sure to follow Banged Up Bills on Facebook, on Twitter @BangedUpBills, on Reddit at u/BangedUpBills, and online at www.bangedupbills.com. Thank you for reading and GO BILLS!