ronald-acuna.jpg

Stop me if you've heard this one before: Ronald Acuna's knee is hurting.

You may remember that a torn ACL cut his 2021 short. (That was the year when the Braves went on to win the World Series, it's worth pointing out.) You may also remember that he was plagued by knee soreness the following year, requiring occasional days off to manage the pain.

Last year, there was no drama surrounding his knee, and last year, he delivered a Fantasy Baseball performance for the ages. Here's a reminder of what that looked like, though by now you could probably quote the numbers by heart:

player headshot
Ronald Acuna RF
ATL Atlanta • #13 • Age: 26
2023 Stats
AVG
.337
HR
41
RBI
106
R
149
SB
73
OPS
1.012

Unfortunately, the knee drama has been renewed for 2024, though at this stage, it's more of a mystery than a drama. To summarize, Acuña was scratched from Friday's spring training game, then was sent for what the team called precautionary MRI, then was found to have "irritation" in the meniscus area. The Braves volunteered that he should be ready for opening day but also said they were sending him to Los Angeles to see Dr. Neal ElAttrache, the surgeon who performed his ACL repair in 2021.

On the one hand, that's good news. The team's doctors, who are of course highly trained in these matters, ruled the injury to be a minor one and even went so far as to offer a timetable, which isn't usually what happens when the diagnosis is in doubt. But there is enough doubt that the Braves are sending him for a second opinion -- and flying him across the country to get it.

Fretting doesn't solve anything, and as someone who isn't trained in medical matters, fretting is all I can do. But Dr. Jesse Morse is indeed trained in medical matters and does a great job analyzing sports injuries on the website formerly known as Twitter. Fortunately, he saw fit to do this with Acuña, laying out what seems to be three favorable scenarios and one terrible one:

Allow me to break them down one by one.

Scenario 1: No significant damage to meniscus, short rest prescribed

"No significant injury deemed to the meniscus. No significant treatments needed, maybe a cortisone shot and some physical therapy. Return in 1-3 weeks." -Dr. Jesse Morse

This seems to be the Braves' diagnosis, and it would suggest that by opening day, this whole episode is water under the bridge. Maybe Acuña favors the knee early, cutting into his stolen base output, but maybe not (more on that in a bit). Chances are that if things were to play out this way, the subject of Acuña's knee would fade into a distant memory, becoming one of those preseason overreactions that we chuckle about when reflecting over another MVP-caliber campaign. It's the best best-case scenario, and by the team's judgment, it may be the most likely one.

Scenario 2: Some damage to meniscus, but rest still prescribed

"Concern for partial tearing, or pain associated with the meniscus, leading to swelling and a conservative approaches taken, but with a non-surgical mindset. This likely means a combination of PRP or stem cells injected into the knee along with physical therapy [and a] return to play [in] 4-6 weeks." -Dr. Jesse Morse

This diagnosis would add an element of uncertainty, to be sure. Even if Acuña is ready to go in mid-April, we'll be left to wonder if the meniscus was properly addressed or if he'll have to battle knee pain off and on, perhaps even shut things down at some point. But he'd still be the No. 1 pick -- if a more fraught one -- because the statistical advantages even while factoring in this reduction in playing time would still be enormous.

Would he run less? Maybe, but I'll note that while playing with off-and-on knee pain in 2022, his first year back from the torn ACL, Acuña still showed plenty of inclination to run, swiping 29 bags in just 119 games. And that was before the new rules that promoted more base-stealing across the league last year.

Scenario 3: Small section of meniscus is removed

"There is a a large enough piece of the meniscus that is torn to prohibit him from playing the entire season safely on that knee. ... Since the meniscus does not have a good blood supply, it does not heal well on its own, and as a result would only continue to bother him if this was not addressed. ... He would likely miss 4-6 weeks." -Dr. Jesse Morse

The timetable isn't any longer here, and for our purposes, it might be preferable to Scenario 2 because we would have the assurance that the necessary action was taken. Again, Acuña would likely miss a chunk of April, but again, he'd still deserve to be the first overall pick in Fantasy.

And maybe he'd be even more inclined to run than in Scenario 2 since he'd know the issue was dealt with. The intervention would have been taken to address the pain, mostly, and we know that Acuña, as much as any player, relishes the rules introduced to promote more stolen bases last year, treating it as a cat-and-mouse game with the pitcher. My guess is he wouldn't be able to help himself.

Scenario 4 (the bad one): Damage is too large for removal and requires a repair

"In this last scenario, the majority of his season would likely be over, as these usually take about four to six months to heal. Let's hope it is not this last option." -Dr. Jesse Morse

Yeah ... that's the one that would cast a pall over this entire season, crushing the value of what should be the most obvious No. 1 player we've had in years.

What does this mean for Acuña's ranking?

For now, nothing. The doctors who have examined him have said it's only irritation and that he'll be ready for the start of the season (Scenario 1, in other words). Maybe they'll be overruled, but it's irrational to presume as much. In any case, we'll cross that bridge when we come to it.

If Scenario 2 or 3 comes to pass, the ranking shouldn't change. Without the injury, he's maybe the most dominant No. 1 pick we've ever seen, routinely going for $20 more than any other player in the salary cap drafts (otherwise known as auctions) that I've taken part in so far. If you reduce his 2023 production by one-eighth (and it may not even be that much), you still arrive at 36 homers, 64 steals, 93 RBI and 130 runs to go along with a .337 batting average. If you reduce that stolen base number even more -- to 40, let's say, just for the sake of prudence -- he's still on another level from everyone else. I'd want to adjust that salary cap number down a bit, putting it closer to $50 than $60, and it may turn out to be a blessing if it means I'm more likely the top bidder.

If, however, Scenario 4 comes to pass, then what a mess drafting Acuña becomes. The difference between a four-month recovery and a six-month recovery is the difference between a half-season and what might as well be a full season. A half season gives him a shot at, well, half his 2023 production -- which would be 21 homers, 37 steals, 53 RBI and 75 runs -- but that's the best-case outcome within the worst-case outcome and not the most reasonable presumption. More likely, Acuña is sliding to the back half of your draft, being taken outside the top 40 outfielders. A deeper league means a lower caliber of fill-in, which makes it even harder to justify.

So there you have it: all the ways this meniscus issue could play out for Acuña. Come Monday afternoon, we should know with more certainty which one we're dealing with. For now, we hold our breath.