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Matthew Betz
FaniumMD: Time to sell Todd Gurley?

Medical expert breaks down the long term impact of Todd Gurley’s arthritis in his knee

Mar 3rd

Introducing Matthew Betz

Matthew Betz is a Board Certified Orthopedic Clinical Specialist and Physical Therapist. He joins the Fanium team to make sure our community always knows how to most optimally react to injuries for their dynasty teams, fantasy drafts, and DFS lineups. He begins by breaking down the recent report of arthritis in Todd Gurley’s knee.


  • Gurley’s 2014 ACL tear as a member of the Georgia Bulldogs increased his risk for arthritis in his knee
  • Now that he has developed arthritis, the Rams will manage his workload so he may not be the workhorse he previously has been
  • Gurley is so productive that he will still be a locked in RB1 even with a reduced workload so buy low on him if an owner panics based on this news
  • If you can sell Todd Gurley for another elite asset without injury risk (e.g. Barkley, Elliot, McCaffery), you should probably do so.

Full Report

Finally, after about two and a half months of uncertainty and ambiguity in Los Angeles surrounding the knee of their superstar running back, we have answers. Late in the season and in the postseason on their way to the Super Bowl, the Rams barely used their franchise player. Todd Gurley’s limited usage was due to soreness and pain in the knee, not due to a new injury. About three days ago, The Athletic’s Jeff Howe reported that Gurley is dealing with arthritis in his knee and fantasy owners immediately hit the panic button. Is this big news, or should we have seen this coming all along?

Todd Gurley tore the ACL in his left knee in 2014 while playing for the Georgia Bulldogs. Right around this time in 2015 when the NFL combine and draft were approaching, Gurley’s knee was a hot topic as people were discussing what the torn ACL meant for his NFL future. Throughout the early part of his career, he put those questions to bed, torching NFL defenses with consistency on his way to being one of the top assets in fantasy football. One thing fantasy football owners love when it comes to Gurley is the every down usage and heavy workload he receives on a week in and week out basis. In his four-year NFL career, Gurley has averaged 260.5 carries/season and 307 total touches/season. When you break that down on a game by game basis, that’s nearly 21.2 touches/game. Sadly, however, those days are likely over, as it’s almost a certainty that Gurley’s workload gets dialed back for the remainder of his NFL career…and that is a very good idea.

Guys like Jay Ajayi, Sony Michel, and now Todd Gurley get a bad rap because of the “bone on bone” or “arthritis” that is present in their knee, but fantasy football owners need to understand that this is simply the reality of what happens when you tear your ACL. It’s not a matter of if but a matter of when a player will develop arthritis in the knee after an ACL reconstruction surgery. About ⅔ of athletes who tear their ACL and have surgery will go on to have arthritis in their knee later in life with some studies citing numbers as high as nearly 80%! Generally speaking, more than 20% of individuals 10 years out from surgery will develop arthritic changes in the knee joint when observed on x-rays and at 20 years out, more than 50% of those people will go on to have those changes in the joint.

When the arthritis develops is the key for guys who are hoping to prolong their NFL career. As we’ve seen now with Gurley, more isn’t always better. More carries, more snaps, more receptions, and more practice volume will all contribute to the acceleration of the development of arthritis in the knee after an ACL surgery. With all things considered equal, a player who averages 10 touches/game is less likely to develop arthritis in the knee than a guy getting 25 touches/game. Simply put, volume and accumulative stress to the joint exponentially increases the rate of arthritis that develops in the knee.

Now understanding all of this, it makes complete and total sense that Rams general manager Les Snead told reporters late last week that the team plans to change the way they use Gurley moving forward. Here’s his direct quote: “There’s an element of wear and tear and I think we have to determine in probably two stages: Are we going to give him the amount of load that he’s had in the past? Or are we going to lessen that load to, let’s say keep him fresher for the season and for seasons beyond…And then, if you go that route, you have to have a good, let’s call it ‘Batman and Robin’ combination, or add another superhero figure into that and figure out how you’re gonna do it. So recovery and things like that have to come into it. But it’s something we want to be intentional about and proactive.”

Snead’s quote says it all. The Rams will need to focus on recovery in order to minimize the wear and tear on Gurley’s knee if they hope to keep him healthy for 16 games in 2019 and beyond. The reality about arthritis is that once you have it, it doesn’t go away, and it doesn’t get better. Arthritis is essentially a term used to describe the loss of cartilage in a joint. When the cartilage starts to become thinner, it does not grow back or get stronger – it can only get weaker, further worsening the condition. As a result, the Rams would be very smart to focus on keeping Gurley fresh by limiting his overall workload each week. The days of Gurley receiving more than 300 touches each season are over.

From a fantasy football standpoint, this is obviously a big hit for Gurley’s value, but let’s not jump ship quite yet. Todd Gurley finished 2018 as the #1 overall running back, posting 342.6 fantasy points in half PPR formats. What’s crazy is that he did this in just 14 games, making his per game average about 24.5 fantasy points. When you break that down by how many touches Gurley received in 2018, he averaged 1.12 fantasy points per touch. Let’s just say for example that Gurley gets 75% of the workload he did in 2019. If he scores 1.12 points per touch on roughly 230 total touches (75% of 307), he scores about 258 fantasy points. This still would have made him RB6 in 2018. What does this all mean? Gurley is still an elite fantasy option, but he’s probably not going to be the 1.01 in redraft leagues come August. In dynasty, Gurley may not play into his 30s, but he should still be an RB1, even with a reduced workload. If there’s an owner in your league looking to get out from Gurley because of the recent news, capitalize immediately.

Insight by
Matthew Betz