It’s the middle of July, and the fantasy football season is officially back! In fact, the Fantasy Footballers podcast has gone to three episodes per week and in August, you can get an episode every day with the show going to five shows per week! With the return of fantasy football, that means training camp is officially about to start, and before we know it, Preseason football games will be on our TVs…fantasy football fans rejoice!

With August quickly approaching, it’s time to start planning for fantasy football drafts. One strategy that can be advantageous for fantasy football owners is drafting players who were injured the previous season. These players can often be had at a value if their injury is one that is unlikely to recur or has good success rates after rehab and/or surgery.

It’s hard to believe, but last year’s RB1 overall in fantasy football is in this discussion and is currently one of the most controversial topics in the game we all love. Will Todd Gurley, who scored a whopping 342.6 fantasy points in just 14 games, be a stud once again at the RB position for owners, who does his knee present a risk that isn’t worth the draft capital? To fully be able to answer the question of what to do with Todd Gurley in 2019 fantasy football drafts, we need to start by understanding what exactly is going on with Gurley from a medical perspective.

Editor’s note: Want access to more of Matthew Betz‘s injury analysis? Find Matthew’s Injury Report in the Ultimate Draft Kit.

Todd Gurley’s Knee Injury and Early NFL Career

Gurley’s knee troubles started in 2014 while in college at the University of Georgia. As a junior, Gurley tore the ACL in his left knee. Despite the season-ending and college career-ending injury, Gurley decided to enter the 2015 NFL Draft, where he was selected 10th overall by the then St. Louis Rams. In his rookie season and first year back from ACL reconstruction surgery, Gurley got off to a slow start, which isn’t surprising given his injury and the average 55-week recovery for NFL players who tear their ACL. However, once Gurley got back on the field, the Rams weren’t shy about using him. In his rookie season, he totaled 250 touches in just 13 games, averaging 19.2 touches per game. As a rookie, Gurley flashed the impressive skillset that made him a top-10 NFL Draft pick. He showed that he was effective in his first season back from ACL surgery, posting more than 1,000 rushing yards and 10 TD.

Is Gurley’s Workload a Problem?

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To date, Todd Gurley has received a total of 1,229 touches during his regular-season contests, an average of 21.2 touches per game over the course of his 4-year NFL career. When you factor in the history of major ligament reconstruction and surgery, the workload is a bit of a problem when you look at longevity at the running back position.

On average, NFL running backs have a career length of 2.57 seasons. Now, we can’t totally buy into that number as an end all be all because of the fact that we know draft capital matters. First-round draft picks have an average career length of 9.3 seasons and if a player makes at least one Pro Bowl appearance, the career length on average increases to 11.7 seasons. Todd Gurley checks both of these boxes, but he’s also got one big glaring issue – a history of a major ligament reconstruction surgery. There has been much research on Career Length and the Data that supports injury analysis.

Research suggests that about 20% NFL wide receivers and running backs who tear their ACL never go onto return to the field. In those that do return to the field after ACL reconstruction surgery, on-field performance decreased by about a third.

Another study suggests that about 18% of NFL players who do return to the field after ACL surgery go on to suffer a subsequent ACL injury – sometimes to the same knee, sometimes to the opposite knee. For reference, Jamaal Charles fits this mold.

The fact that Todd Gurley has produced at the level he has for this many seasons in a row after his injury is a feat in and of itself. It’s impressive. After all, he was the RB1 overall in back to back seasons, something that rarely happens. Can this trend continue? Is he worth the draft capital? And what should you do with Todd Gurley in fantasy football?

How Does Arthritis Affect NFL Players and How Will it Affect Todd Gurley?

The research suggests that an individual’s likelihood of developing knee arthritis after ACL surgery is elevated. Generally speaking, more than 20% of individuals 10 years out from surgery will develop arthritis on an x-ray, and more than 50% will develop arthritis 20 years out from surgery. At 5 years out from surgery, about 11% of athletes demonstrate arthritis. So, simply put, arthritis is going to develop after ACL surgery, it’s just a matter of when.

For Gurley, he falls into that 11% of athletes who develop arthritis sooner than later. This could be due to his whopping 1,229 career touches on top of his playoff touches and his practice reps, not to mention his offseason workouts. Arthritis develops due to repetitive ‘wear and tear’ on the knee joint – running, jumping, cutting, taking hits, weight lifting, etc. All of these loads to the knee can accelerate the development of arthritis, but the issue is that there is no magic number in terms of reps or sets. Every individual is different and every body is different. With that being said, 2019 will likely be a season of trial and error for Gurley and the Rams.

The Rams won’t be able to pre-determine how many touches will be safe for Gurley vs. how many touches will be problematic. Instead, they’ll have to rely on Gurley’s symptoms – pain, swelling, stiffness, soreness, etc. With that being said, it’s nearly impossible to predict exactly how Gurley’s knee will respond. But, if we use 2018 as an example, a similar outcome is likely.

Todd Gurley was on pace for 360 total touches in 2018 if he would have played 16 games. If the Rams try to utilize Gurley in that way again in 2019, a similar outcome is likely. However, now that the team knows Gurley has an arthritic knee, there is absolutely no way they will employ him in this way.

What To Do With Todd Gurley in Fantasy Football Drafts

So, if Todd Gurley isn’t going to get 360 touches in 2018, what can we expect for fantasy football purposes? Well, let’s start with what we know – Players who have ACL surgery are likely to have a shortened career. In general, players who have ACL surgery perform worse when they get back on the field in future seasons. And, moreover, players who have ACL injuries and arthritis go on to miss more games in their career.

If we go based off what the numbers say, Todd Gurley is likely to miss more games in his career if the Rams give him a full workload. Simply put, more touches equals a more rapid rate of progression of arthritis in the knee. Because of this, it’s extremely unlikely that the Rams utilize Gurley in the true workhorse fashion that they have thus far. Just last year, the Rams signed Gurley to a 4-year, $57.5 million contract with $45 million of that being guaranteed. Certainly, the front office will want to get the most out fo their investment. They will be smart with his usage in 2019 and beyond.

There is little doubt that the team will utilize backups Malcolm Brown and rookie, Darrell Henderson, in 2019. Fantasy football owners need to come to the realization that the days of Todd Gurley being an every-down back are over…but that’s okay.

If we examine Gurley’s production profile over the last two seasons with Sean McVay, he averages 1.05 fantasy points per touch. To fully examine the range of outcomes for Gurley in 2019, let’s look at his floor and his ceiling. These are merely gut projections in terms of his ceiling and floor but are certainly within the realm of possibility.

On the low end of things, let’s say Gurley only gets 175 touches in 2019 (11 touches per game). Based on his recent average, that would equate to about 183.75 fantasy points. In 2018, that would have been the RB17 in fantasy football. On the higher end of things, let’s say Gurley gets 250 touches (15.6 touches per game). Based on his .87 fantasy points per touch average, that would equate to 262.5 fantasy points. In 2018, that would have been the RB6 in fantasy football.

I put up a recent poll on Twitter, asking what you, the fantasy football owner, would do with Gurley in your draft. As of the writing of this article, about 60% of followers aren’t willing to draft Gurley at or ahead of his current ADP, and that would be a mistake.

Todd Gurley presents fantastic value in fantasy drafts. According to Fantasy Football Calculator, Gurley is currently going as RB11 off the board in the 2nd round. I would expect his ADP to continue to fall, and it’s not unrealistic to expect Gurley to come off the board in the range of RB15 overall. At his current price (and potentially future price), he offers great value, as he’s a member of one of the best offenses in the NFL who is going to score a lot.

Even if Gurley secedes touches to Henderson and Brown in between the 20s, Gurley will most certainly be utilized heavily in the red zone. Last year, Gurley led the NFL in rush attempts inside the 10-yard line. If that trend continues, expect Gurley to continue to produce fantasy points on a weekly basis. There’s a chance that Gurley ends up being drafted in August at his floor, but for the upside, the Gurley presents in a very conservative projection at 15.6 touches per game, Gurley offers top-6 upside at an RB2 price. Sure, he comes with risk but if Gurley hits in 2019, he’s a league winner at his 2nd round price.