2022 NFL Draft Injury Impact: Alabama WR Jameson Williams

03/08/2022
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Quite possibly one of the hottest wide receivers in the 2022 NFL Draft is none other than Alabama WR Jameson Williams. Coming off a breakout season in which he posted 79 receptions for 1,572 yards and 15 touchdowns, he was selected All-SEC as he helped bring the Crimson Tide to the National Championship game. 

However, Williams had his draft stock take a shot when he tore his left ACL in the title game. This was the result of a 40-yard reception over the middle of the field early in the second quarter. He attempted to slow down and cut to his right before his left knee buckled, leading to the ACL tear. He left the game with four receptions for 65 yards and would have likely had much more if not for the injury.

Despite the injury, it appears most teams still have him highly rated on their boards heading into the NFL Draft. As with any injury, every team determines the risk associated with selecting a player coming off a common, yet concerning injury. Could Jameson Williams be a target for the Buffalo Bills at pick 25?

Injury history

Williams appeared in 37 games over the course of his college career, playing at Ohio State for his first two seasons before entering the transfer portal and selecting Alabama for the 2021 season. Besides the left ACL tear, Williams has no other publicly reported injury history dating back to high school. 

Regarding his ACL tear, reports following surgery from famed orthopedic surgeon Dr. James Andrews reported that it was a clean tear. This means that while the ACL was torn, there wasn’t any associated damage such as MCL, cartilage, or meniscus commonly seen with ACL injuries. Ultimately, this will help in the rehab process and reduce complications upon returning.

Williams had surgery on January 18th, just one week following the injury. There is sometimes a long delay in performing surgery to prevent arthrofibrosis in the joint during rehab. However, due to the lack of associated damage and the draft, surgery was likely performed as soon as possible to maximize a return to the field.

Knee anatomy

The ACL is a ligament that runs lateral to medial and prevents anterior translation of the femur over the tibia. This ligament assists with rotational stability by preventing the knee from rotating at the tibia, ensuring that the knee acts as a hinge joint. The ACL contains mechanoreceptors that assist with detecting changes in direction, speed, and tension. It is the most commonly-torn ligament in the knee during sporting activities.

Normal knee anatomy and torn ACL. Credit: Aquaphysicaltherapy.com

Causes for injury include a sudden change of direction, jumping, poor landing, deceleration, or direct blows to the area. There is usually, but not always, associated damage to the area during an ACL tear, including damage to the meniscus, articular cartilage, and MCL. Damage to the PCL and LCL is also possible, along with nerve and vascular damage in severe knee injuries. Recoveries for an ACL tear vary between 9-12 months but can take even longer with associated damage, as mentioned above. 

Injury Risk

Despite the ACL tear being Williams’ only known injury, it is worth wondering how he will respond to the rehab process and return to the field when he is cleared. Athletes sometimes have that aura of invincibility when they play. 

When they have an injury and they return, there can be that little voice in the back of their head that says “what if this happens again?” or “I better take it easy to avoid injury”. This is seen in high-level athletics down to everyday people. The body is far more resilient than what we give it credit for at times, but the concern for injury or making something worse can be the far bigger hurdle to clear.

Looking at the re-injury risk, Williams still has to rehab through the spring and summer before he’s even cleared for practice. There are several risk factors that are against him coming into the season that could affect his production at the next level. These could all increase his chances to suffer a future ACL injury once he reaches the NFL. They are:

  • He is currently, 20, will be 21 by the time the season starts. The re-tear rate for players under age 25 is 23 percent.
  • The overall two-year window for re-tear either the same side is 7 percent for the same side, 8 percent for the contralateral side for 15 percent total.
  • Increase in the level of competition (NCAA < NFL).

Williams has also gone on record stating that he was informed by his rehab staff that this is a 5-7 month recovery. He further stated that he expected to be ready for training camp, but there were no guarantees.

Orthobiologics

While that does seem like an incredibly aggressive timeline, and it is, it’s not without precedent. Dr. Andrews and Dr. Lyle Cain, the surgeon that reconstructed Williams’ ACL, have recently been using stem cells to accelerate the healing process. According to Andrews, they wrap the ACL in a cocoon-like structure, injecting it with stem cells and blood plasma. 

While I do love the idea that this could speed up ACL rehab and potentially decrease injuries, this isn’t without risk. The rehab and healing of the repaired tissue still need to take place. This can’t be sped up. My concern with trying to return too quickly is that the ramp-up period in returning to play could lead to further injury.

Could the healing process be reduced so much that the same outcomes can be achieved with a similar rehab program? Everything going right could lead to a player returning in six months. Clemson WR Amari Rodgers did just that, missing only the season opener in 2019 after tearing his ACL in March of that year. Rodgers was ultimately drafted by the Green Bay Packers in the third round in 2021. 

It’s important to note that Clemson’s team physician, Steven Martin, performed the procedure. According to the article, the team has been using the stem cell approach for about five years. This includes this technique performed on current Houston Texans QB Deshaun Watson in college on his left knee in 2014. Watson later tore the ACL in his right knee in 2017. 

Other athletes to have this technique performed are former Auburn WRs Will Hastings and Eli Stove in 2018. Hastings returned in five-and-a-half months, Hastings returned in six months. Regrettably, Hastings and Stove have not had much of an NFL career to this point. Hastings was a UDFA and signed to the New England Patriots practice squad in 2020 before his release. 

Stove was signed by the Los Angeles Chargers in 2021 as a UDFA, but suffered a torn ACL at some point and was waived due to not passing a physical prior to minicamp. It’s not clear if this was the same or opposite side from the 2018 injury. 

While it is not proven that Williams had this approach performed, there’s a certain level of confidence that he did receive this procedure. Dr. Lyle Cain is one of the best orthopedic surgeons in the sports world, but no doctor has a 100 percent success rate either. I do love the idea of using new techniques including stem cells to speed up the timeline for ACL rehab. 

However, applying this approach to everyone and lowering the bar for return to sports could be tricky. This could set unrealistic expectations for others or athletes may try to return too soon. According to the Journal of Orthopedic & Sports Physical Therapy, athletes who return to sport prior to nine months following an ACL injury are at a seven-fold greater risk to suffer a future ACL tear. 

One of the key points of the study was that to reduce the incidence of future injury was to achieve symmetrical muscle function or quadriceps strength in both legs. The study did not find that there was an increase in ACL injuries once that benchmark was met. That benchmark could be compromised if an athlete is pushing to return despite not being fully physically ready.

Would the stem cells speed up the ability to hit certain benchmarks in the ACL rehab? Very possible. Could it allow for the increased ability to regain the strength necessary to return to sport? Also very possible. There are other techniques including blood flow restriction that could help further maximize a return to sport. This could suggest that a multi-faceted approach may be more effective than simply bathing the ACL graft in stem cells alone. 

Buffalo Bills Draft Impact

I don’t hate the idea of picking an elite talent at pick 25 on a “discount”, especially with the lack of associated injury history. This severely deviates away from the drafting patterns seen by GM Brandon Beane in past seasons. Past results do not guarantee future outcomes, but with the Bills in a Super Bowl window, they may be willing to take a risk. They will clearly have more data on the stem cell approach and comparables when considering their selection. They also may not be on board yet with some of the aggressive approaches being developed. 

If Williams falls to the Bills, I don’t anticipate that he plays until midseason at the earliest due to continuing rehab. By the time training camp starts, he will be six months removed from surgery. I don’t anticipate the team allowing him to be cleared to play football, especially with the chance to re-tear still so high. The training staff for the Bills is ultimately in control despite Williams’ anticipation that he returns by training camp. 

All it takes is for one team to fall in love with a player and Williams is maybe someone that another team loves before the Bills select. Injuries alone do not always derail a player’s draft stock. We have seen that with the Miami Dolphins selection of QB Tua Tagovailoa with his hip injury, going fifth overall. The Tennessee Titans took injured players in DT Jeffery Simmons and CB Caleb Farley in the first round, both with ACL injuries with differing outcomes so far.

The Bills need players capable of being available immediately; their draft history supports that. There also isn’t a guarantee that Williams returns to his prior form with only one year of elite production at the collegiate level. 

However, I would be comfortable picking him knowing that he can potentially play later in 2022 and be fully healthy in 2023. There is a distinct possibility that he will be selected by another team prior to the Bills’ selection at pick 25. 

Williams has a long road ahead of him before he gets to step onto an NFL field in 2022. Elite talent and the Buffalo Bills are phrases becoming synonymous with each other. The Bills could potentially get a discount on top-end talent if Jameson Williams is available.

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