Pretty solid.
When i first started playing, i had very low expectations and figured it would be another boring, low quality game like most other mobile games, but i was actually pretty surprised by how good it is, although it’s not “perfect”, I still got some enjoyment out of it, and the ads are definitely noticeable, but to be fully honest that’s how most mobile games are, and the ads in this one aren’t super overwhelming like most other mobile games, my only two recommendations would be a possible option to disable the slow motion effects when breaking a bone, and maybe an option for enabling screen effects like flashing colors for concussions, hemorrhages, etc…