After trading away David Montgomery, the Detroit Lions needed to add to the RB room. They did that on Day 2 of the NFL free agency negotiation period by agreeing to terms with Isiah Pacheco. This hard-running RB carries a long injury history. How concerned should the Lions be?

The following is an excerpt from my Detroit Lions Day 2 free agency medical report.

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(Ages in parentheses are at start of 2026 season.)

Isiah Pacheco, RB (27)

Contract: 1 year, $1.81 million fully guaranteed plus undisclosed incentives

Concern level 6/10

Included are Yards/Attempt stats

This hard-running RB has a long list of injuries in his time in the NFL. Over the past 4 years, he’s had at least four surgeries.

His latest injury was a moderately significant MCL which generally heal very well (see David Montgomery), so there isn’t much concern here unless he had some associated cartilage damage.

In the prior year, he had a fractured fibula. Missing nine games is not bad for a fractured fibula as there is the potential of a much worse injury – see James Houston who missed four months with the Lions due to associated ankle joint damage. If this is an isolated bone fracture, there should be minimal residuals.

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A couple shoulder surgeries in 2023 are a concern going forward with the amount of trauma that a RB shoulder must endure. Recurrence is possible here.

The hand fracture from 2022 is of minimal concern.

While he may be healthy right now, there is concern for accumulation of residuals. His yards per attempt has taken a dramatic dip in the last two seasons which could reflect those residuals. The short contract at a low value implies that teams share those concerns.

On the positive side, his age of 27 is still in his prime and a couple years younger than the guy he’s replacing (Montgomery 29).

Given that Pacheco has missed 13 games in the past two seasons, the Lions would be wise to have a 3rd quality RB that they can count on. That might be a target in the mid-rounds of the draft.

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This article originally appeared on Lions Wire: Detroit Lions free agency injury report: Isiah Pacheco, RB