Acho played in 48 games during his 4-year career at Texas, including 26 starts. As a senior, he was consensus first-team All-Big 12 linebacker (Coaches, AP, Houston Chronicle, San Antonio Express-News, Fort Worth Star-Telegram). He won the 2010 Arthur Ashe Award, was named to the 2011 AFCA Good Works Team, and was a three-time first-team Academic All-Big 12 selection. He was also a finalist for the 2011 Lott Trophy for college football’s Defensive IMPACT Player of the Year, Lowe’s Senior CLASS Award and Wuerffel Trophy. He led his team in tackles in 2011 and, over his 4-year career, recorded 278 tackles (159 solo), 41 TFL, eight sacks, seven forced fumbles, three fumble recoveries, two INTs, 13 PBU and 26 pressures.

He graduated in December 2011 with a degree in sports management.

Acho was drafted by the Cleveland Browns in the sixth round of the 2012 NFL Draft. He was placed on injured reserve after a leg injury and missed the entire 2012 season. On April 11, 2013, Acho was traded to the Philadelphia Eagles for running back Dion Lewis. He was released on September 2, 2013. On September 10, 2013 Acho was signed to the New York Giants practice squad.

The Philadelphia Eagles signed Acho off the Giants’ practice squad on October 21, 2013 after Jake Knott was injured, and he saw limited playing time in 6 games, getting his first NFL tackles. He was made gameday inactive once Mychal Kendricks and Jake Knott were back. Acho was waived by the Eagles on December 17, 2013, before the season ended, but signed to the practice squad the next day. He was resigned to the team on January 6, 2014 during the off season; released on August 30, 2014 and then added to the Eagles practice squad the next day. Acho was promoted to the active roster on September 9, 2014 after Najee Goode was injured. Following DeMeco Ryans’ season-ending injury in Week 9, he was thrust into a prominent role, along with Casey Matthews. He played in 14 games and recorded 31 tackles. In 2015, after being waived as part of the cuts to 53 due to a thumb injury, Acho was signed back to the Philadelphia Eagles on November 9 after Jordan Hicks was placed on Injured Reserve with a shoulder injury, but he saw no playing time and was released on November 24, 2015, making him a free agent.

On January 9, 2015, Eagles fan Hannah Delmonte contacted Acho via Instagram. Delmonte asked Acho to escort her to her junior prom if she received 2,000 retweets on Twitter. Acho felt 2,000 retweets was too low, so he increased it to 10,000 retweets and gave Delmonte one week to meet the goal. Less than three hours later, Delmonte posted a picture showing that she’d received over 10,000 retweets, and Acho accepted the invitation. On February 20, 2015, Acho took time off from his graduate studies at the University of Texas and flew to Purcellville, VA, to personally accept Delmonte’s prom invitation, nicknamed ‘Promposal’ by the media. On May 9, 2015, Acho escorted Delmonte to her junior prom in Purcellville, VA.

While still hoping to be signed, Acho took a temporary job in 2016 as an analyst for the Longhorn Network and then transitioned to a full-time analyst that fall. In 2018, he was promoted to ESPN2’s college football programming. Acho was one of four hosts of “Cover Four” which airs on the official website of the Dallas Cowboys, and is one of four anchors at the Texas Gameday Desk on the Longhorn Network. On June 10, 2020, it was announced that he would be leaving ESPN to join Fox Sports and co-host the afternoon studio show “Speak for Yourself”, replacing Jason Whitlock. He is also a baritone and piano player, as his rendition of The Eyes of Texas was featured in Ricky Williams’ A Football Life.

Acho has continued his family’s medical missionary work, writing in a 2018 tweet: “Everybody wants to be the #BlackPanther until it is time to actually save lives in Africa. My family’s annual mission trip to #Nigeria COMPLETE! We treated over 1,800 patients, performed 162 surgeries & tried to love like Jesus does.”

In early summer 2020, Acho began a series of Youtube interviews entitled, “Uncomfortable Conversations with a Black Man”, hoping to address issues of race in America. A book of the same name was released on November 10, 2020, which sold 18,000 copies in its first day.