Episode 295 | Two NFL Players, Two Very Different Paths Back From ACL Surgery

What is up team and welcome back to another episode on the ACL Athlete Podcast. Today, we are talking about two NFL athletes and two very different recoveries. One of them just came back from a torn ACL and LCL and played on Monday night in Week One. The other is still waiting, and he got absolutely ripped in the comments for it. When you see people commenting on his answers and his particular case on social media, they are absolutely blasting him, and it is really interesting to look at because each person has a completely different context.

Patrick Mahomes and Michael Penix Jr. have the same injury label in terms of an ACL injury, but it is not the same injury. That is what this episode is about: we cannot compare one person’s recovery to another. I know we have talked about comparison and recovery in the past, and I even did an episode recently about comparison, but I think it is important to talk about this using examples we are seeing in the media. These examples are shaping people’s perception of ACL rehab, and they might even be shaping your own. We cannot necessarily compare one person to another, especially not one professional athlete to another, and certainly not you to an athlete you follow on Instagram, see in a clinic, or read about on a forum.

Even if you and another person had the same type of injury, there are still layers of context that make the recoveries different. Let us say you both tore your ACL skiing or playing soccer, around the same time, and even had the same procedure and the same graft type. That would make the situations more similar, but it still would not make them identical.

What brought this up for me was that one of the members of my team sent us a video of Michael Penix, the Atlanta Falcons quarterback, answering a reporter’s question about his ACL recovery and when he would play again. He was asked to compare his timeline to Patrick Mahomes, the Kansas City Chiefs quarterback, and when I looked at what people were saying about Penix, they were absolutely ruthless. That was really sad to see, but it highlighted something important about the public’s perception of ACL recovery. 

People often assume that every ACL recovery is essentially the same. It is honestly similar to assuming that every pregnancy and delivery is the same. You might think, “Okay, it happens to each person,” but anyone who has had a child, especially multiple children, can tell you that pregnancies, deliveries, and recoveries can be completely different. Even within the same person, you cannot necessarily compare one ACL tear to a second or third ACL tear, and when you line up 10, 20, or 100 different people, the differences become even more obvious.

The perception, though, is often that everyone should follow the same timeline. If one athlete comes back in six months, people ask why someone else cannot do it. If another athlete comes back in nine months, they wonder why someone else has not reached that point. People are not always considering the factors that layer into those decisions. I understand why, because if you are not immersed in this world, what do you hear? You hear about professional athletes, and you hear nine months, especially now. Every headline seems to mention around nine months, which is already better than when six months was commonly thrown around. But nine months is a floor or bare-minimum benchmark for many people, not a magical finish line. When someone says an athlete returned in nine months, that can be a proxy for the earliest end of a reasonable timeline depending on the individual context. 

One surgeon has even said on the record that a high-performing athlete returning in nine months or sooner would not be unusual. That kind of messaging can be enticing, especially when someone says, “I can get you back in six months,” or, “I can get you there in nine months.” Yes, it can happen, and there are plenty of people who do it, but depending on the individual, the graft, the sport, and everything else happening in their life, many people are going to be closer to nine months or beyond, toward the 12-month range.

Before we go further, I want to make a quick note that I am not involved with Michael Penix’s case or Patrick Mahomes’ case. I do not have their charts, and I do not know all the details of their medical backgrounds. I am not going to sit here and act like I know everything about either case. Everything I am discussing comes from what has been publicly reported and what Michael himself has said.

Patrick Mahomes tore his ACL and LCL on December 14, 2025, and had surgery the following day. With many professional athletes, there is not much opportunity to take a long period of prehab before surgery because of the demands of their sport and season, so they often move into surgery quickly. He returned Monday night of Week One of this NFL season, September 14, which is just about nine months after the injury. If you look at the exact timeline, it is just under nine months, but we can round it to nine months for the sake of the discussion.

The important thing is that nine months does not automatically mean Mahomes is rushing. There may be an assumption that he is pushing himself because he wants to prove something, but nine months is a reasonable benchmark, and there is research supporting the value of allowing that amount of time. Even during the preseason, he was not as highly involved as he normally would be. He has performance staff, medical staff, and people who should be testing the appropriate things, and he is also thinking about the long term to some degree. At the same time, he is a competitor, and he wants to be out there. This is also his first ACL injury. 

Another important point is that nine months is not a magical timeline where suddenly you become bulletproof against reinjury. It is more of an intersection where biological healing can reach a point at which the ACL can replicate the function and tension of the native ligament from a healing and ligamentization standpoint. The other side of the equation is rebuilding the knee, the body, and the athlete’s physical capacity, and nine months can serve as a useful proxy for allowing enough time for that process.

That said, research from Aspetar has shown that nine months is not necessarily an absolute requirement. It can be more about whether the athlete has achieved the appropriate criteria. We have people who return to activity before nine months, and we educate them about the risks and the research. If someone is at seven or eight months, has high stakes, and is absolutely crushing the criteria, there may be situations where returning earlier makes sense. We are still trying to find the intersection between time, biological recovery, performance, risk, and the individual’s circumstances rather than simply saying that a specific month automatically means someone is ready.

Now let us look at Michael Penix. He tore his left ACL on November 16, and surgery was performed on November 25, around Thanksgiving. This is his third ACL surgery. His first two were on his right knee at Indiana in 2018, and this time, surgeons used a quadriceps tendon graft along with an added LET, or lateral extra-articular tenodesis, which is a procedure intended to address lateral rotational stability and potentially reduce reinjury risk. So we have the same NFL league, the same season, and, in theory, the same label of having ACL surgery. But the headline simply says, “He had ACL surgery.”

That is where the comparison breaks down. It is not “ACL plus quad graft plus LET plus multiple previous surgeries.” It is simply “ACL surgery.” Michael himself explained this when he was asked about Patrick Mahomes. He pointed out that Mahomes did not have the same procedure, that Mahomes was able to use a patellar tendon graft, while Penix had to use a quad graft because both of his patellar tendons had already been used. He also had an operation on the lateral side of his knee and has now undergone his third ACL surgery.

Think about what he did in that answer. A first-round quarterback stood at the podium and explained graft choice to the general public. Both of his patellar tendons had already been used, so his surgeons went to the quadriceps tendon. He also had a lateral extra-articular tenodesis added to the procedure. He has undergone three ACL surgeries. Most people hear “ACL surgery” and picture one operation, but he just told you that it is not that simple.

Then there is another part of his answer that I think is especially important. When he was asked how he would determine when he was ready to face a live defense, he said he had particular goals that he wanted to hit and that he was keeping those goals between himself and the training staff. He said he was close, that he was working extremely hard, and that he wanted to be out there, but he also needed to think about how he felt and what he needed to work on before going onto the football field. That is a very different message from simply giving people a date.

He is protecting that process, and I think that is really important. He is not saying, “I will be back in Week Three,” or, “I will be back in Week Four.” He is saying that he has goals and that he is keeping those goals between himself and his training staff. Those are the criteria he needs to hit. He is giving himself some flexibility instead of handcuffing himself to a calendar date that can then become another source of scrutiny.

I appreciate that answer because he is giving a range rather than promising a specific timeline. Most people are cleared based heavily on time rather than readiness and performance criteria, and he is leaning into the opposite approach. With what is on the line for him, that is an important distinction. He is saying that he wants to return, but he also wants to make sure his knee is where it needs to be before he goes back onto the field.

The last thing I want to share from him is what he said about taking things day by day. He said he was working every day and needed to be where his feet were, that he felt good in practice that day, and that he wanted to keep making strides and feeling better each day. His position was essentially that once his knee feels where it needs to be, he will be ready to play. There is no specific number attached to it, such as Week Three or Week Four.

People sometimes assume that an athlete with this history who is waiting must be scared or mentally hesitant. But Penix specifically said that it is not mental. He wants to play. What he is saying is that he will not go out there until he feels that his knee is where it needs to be physically. Waiting is not necessarily fear. It can be a decision.

I think that is important for every ACLer listening to hear, especially from someone with so much on the line. 

Let us also look at two other NFL players because this is another example of what waiting can look like at the highest level. Nick Bosa tore his ACL on September 21, his second ACL injury as a professional and on the opposite knee from his 2020 injury. His first game back was Week One this year in Melbourne, 354 days after the tear. There are seasonal factors involved here, and I want to acknowledge that. If an ACL injury happens earlier in the NFL season, the season ends and the athlete has more time before the next season begins. If the timing between the injury and the next season were shorter, would that have changed the timeline? Maybe. But I would also argue that these athletes are still taking the time they need to hit the appropriate metrics. 

In Bosa’s case, he took a slower approach compared with his previous process, particularly after dealing with setbacks that he did not need to experience the first time. Then there is Malik Nabers. He tore his ACL and meniscus on September 28 and waited a month for surgery to allow the swelling to settle. He played his first game back last Sunday night, 350 days after the tear. He said he was not going to put his career at risk by coming back too soon, and he did not know he was playing until about two hours before kickoff. He ultimately played, but the team still limited him to 36 of 68 snaps.

When you look at these four players, I am not claiming that their circumstances are identical or that their decisions can be directly transferred to everyone else. The honest range we are seeing here is roughly nine months to almost a year, with Mahomes on the faster end and the others taking more time. Penix is still waiting. That does not mean he is behind. It means his context is different.

And here is where I think the comparison really breaks. In my opinion, Michael Penix has one chance when we really look at the stakes. Patrick Mahomes could potentially reinjure the knee or the other side and still have the opportunity to rehab and play again. If it happens to Penix, it would be his fourth ACL tear. That changes the stakes significantly, and there is much more uncertainty around what another injury could mean for his football career.

There is also a financial and career context to consider. Mahomes is already extremely successful financially and professionally. Penix has much more on the line in terms of his health, finances, lifestyle, and career trajectory. He is also a quarterback on a team where all four quarterbacks are part of the current mix. Waiting is not free for him. He has every reason to want to get going, and yet he is still choosing to wait. That is why I think this matters for everyone listening. These professional athletes have access to extensive resources, their full-time job is their sport, and there are enormous financial incentives to return. They are still taking time before returning to play. 

Meanwhile, some of you are teenagers, some are in college, and others are in your 20s, 30s, 40s, 50s, or 60s. People across all of those age groups are telling themselves, “I need to do this in six months,” or, “I need to do this in nine months.” The problem with that mindset is that you can put yourself in an unnecessary position where the calendar becomes the constraint. Unless you have something extremely important at stake, we have to consider what is actually going on and what is at risk. I would ask it this way: why rush and increase the risk unless there is something genuinely important at stake? These professional athletes have some of the most significant stakes imaginable, and they are still taking their time. They want to return at a high level, but they also want to reduce the likelihood of this happening again. 

One study by Grindem and colleagues followed 106 athletes participating in pivoting sports for two years after ACL reconstruction. They found that the reinjury rate dropped by approximately half for each month return to sport was delayed up to nine months, and 38% of athletes who failed their return-to-sport criteria were reinjured compared with under 6% of those who passed. The broader point is that time matters, but hitting the appropriate criteria matters as well.

There are three things I want you to take with you. Ask, “What are my current criteria for returning?” rather than simply asking, “When can I return?” Do not compare your timeline to anyone else’s, including a professional athlete’s. Write down your context: your graft, the other structures involved, prior injuries, your sport, your position or activity demands, what is at stake, and your life circumstances.

That helps you recognize that your recovery is different from the other 50 quad grafts you have read about or the other people your age who are going through ACL rehab. Your recovery has its own variables. That is important to recognize when you are trying to make decisions about your own return.

Make sure you do it right. Do not rush it. Play the long game and block out as much of the noise and pressure as you can, because we cannot compare one person’s recovery to another.

That is going to do it for today, y’all. I just wanted to share this because I think it was important to highlight these professional athletes and also someone saying something that I think is important for a lot of people in this space to hear. It is helpful to hear this from people in the professional setting and use it to anchor expectations, especially when there is so much at stake for them. I hope this helps.

If you have any questions, please reach out. Otherwise, I will see you in the next episode. This is your host, Ravi Patel, signing off.