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On March 5, 2019, the Bears released Acho, ending his 51-game, 25-start tenure with 140 total tackles (17 on special teams), four sacks, three forced fumbles, and a fumble recovery.

On August 11, 2019, Acho was signed by the Buffalo Bills. He was released on August 31, 2019.

On November 5, 2019, Acho signed a one-year contract with the Tampa Bay Buccaneers, reuniting him with former coach Bruce Arians.

Acho was born in Dallas, Texas. He graduated from St. Mark's School, where he was on the academic honor roll during each of his 4 years of high school. Acho was named to the all conference football team during his last 3 years of high school. He was named team co-captain for both his junior and senior years. He was also the state private school champion in both the shot put and discus. As of 2018, Sam Acho still holds the school record in the 12 pound shot put (57'9.25, while his brother Emanuel is 2nd all time at 57'4.25). In the 1.6 lb discus, Acho is 3rd all time at St. Mark's (162' 3) while his brother Emanuel is first (177'3). During his senior year on the basketball team, Acho averaged 12 points and 15 rebounds per game.

On January 1, 2018, the Bears fired head coach John Fox after they finished the 2017 season with a 5–11 record. Head coach Matt Nagy opted to retain Vic Fangio as the Bears' defensive coordinator. On March 14, 2018, the Chicago Bears signed Acho to a two-year, $5.50 million contract with $2.95 million guaranteed and signing bonus $500,000. On October 8, 2018, Acho was placed on season-ending injured reserve after suffering a torn pectoral muscle.

On April 15, 2017, the Chicago Bears signed Acho to a one-year, $855,000 contract with $130,000 guaranteed and a signing bonus of $80,000.

Acho became a starting outside linebacker for the last nine games of the regular season after Willie Young and Leonard Floyd both suffered injuries and were placed on injured reserve. On December 10, 2017, he collected a season-high five combined tackles during a 33–7 loss at the Cincinnati Bengals. He finished the 2017 season with 45 combined tackles (29 solo), three sacks, a pass deflection and a forced fumble in 16 games and 12 starts. Pro Football Focus gave Acho an overall grade of 59.8, which ranked 88th among all edge rushers.

In 2017, Acho started “Relevant is Doing a Sports Podcast” with RELEVANT Brand Director Jesse Carey and former Willow Creek Pastor Steve Carter on the RELEVANT Podcast Network. The podcast focuses on the intersection of faith, pop culture, and sports.

On March 28, 2016, the Chicago Bears signed Acho to a one-year, $840,000 contract with a signing bonus of $80,000. During training camp, Acho competed to be a starting outside linebacker against Pernell McPhee, Lamarr Houston, Willie Young, and rookie Leonard Floyd. Head coach John Fox named Acho the backup outside linebacker to begin the regular season, behind Willie Young and Leonard Floyd.

On September 18, 2016, Acho recorded three combined tackles and sacked quarterback Carson Wentz during a 29–14 loss to the Philadelphia Eagles in Week 2. The sack became his first since 2014. The following week, he collected season-high four combined tackles in the Bears' 31–17 loss at the Dallas Cowboys in Week 3. He finished the 2016 season with 27 combined tackles (18 solo), a pass deflection, a sack, and a forced fumble in 16 games and six starts.

In a 2016 AOL article, "Six NFL Players with Genius IQ's," Acho is noted to be fluent in 3 languages: English, Spanish, and Igbo.

The Arizona Cardinals finished second in the NFC West with an 11–5 record and earned a wildcard berth. On January 3, 2015, Acho started in the NFC Wildcard Game and recorded seven combined tackles and forced a fumble during a 27–16 loss at the Carolina Panthers.

On April 1, 2015, the Chicago Bears signed Acho to a one-year, $840,000 contract. During training camp, Acho competed to be a starting outside linebacker against Jared Allen, Lamarr Houston, David Bass, and Willie Young. Acho was sidelined for three weeks during the preseason after suffering from mononucleosis. On September 12, 2015, the Chicago Bears terminated Acho's contract after he was ruled inactive due to his illness. On September 14, 2015, the Chicago Bears re-signed Acho to a one-year, $840,000 contract. In Week 5, he collected a season-high six solo tackles during an 18–17 loss at the Kansas City Chiefs. Acho shared starts with Willie Young and finished his first season with the Bears in 2015 with 39 combined tackles (30 solo), a pass deflection, a forced fumble, and one fumble recovery in 15 games and seven starts.

In 2015, Acho earned an MBA from the Thunderbird School of Global Management in Glendale, Arizona. In 2016, both Sam and Emmanuel Acho went to Nigeria to participate in Living Hope Christian Ministries' medical mission Operation Hope.

Acho entered training camp slated as a starting outside linebacker and saw competition from Lorenzo Alexander, John Abraham, and Matt Shaughnessy. Head coach Bruce Arians named Acho a backup outside linebacker to begin the regular season, behind John Abraham and Matt Shaughnessy. On September 14, 2014, Acho recorded a solo tackle, broke up a pass, and intercepted a pass by Giants' quarterback Eli Manning during a 25–14 win at the New York Giants in Week 2. In Week 12, he collected a season-high four combined tackles in the Cardinals' 10–3 loss to the Seattle Seahawks. The following week, he tied his season-high of four combined tackles during a 29–18 loss at the Atlanta Falcons in Week 13. He finished the 2014 season with 31 combined tackles (23 solo), three pass deflections, an interception, and a sack in 16 games and four starts.

On January 8, 2013, the Arizona Cardinals fired head coach Ken Whisenhunt after they finished with a 5–11 record. Defensive coordinator Todd Bowles held a competition for the jobs as the starting outside linebackers between Acho, O'Brien Schofield, Lorenzo Alexander, and Alex Okafor. Head coach Bruce Arians named Acho and Lorenzo Alexander the starting outside linebackers to start the regular season, along with inside linebackers Karlos Dansby and Jasper Brinkley.

He started in the Arizona Cardinals' season-opener at the St. Louis Rams and collected a season-high two solo tackles and forced a fumble in their 27–25 loss. In Week 3, Acho made two solo tackles and a sack before exiting the Cardinals' 31–7 loss at the New Orleans Saints in the third quarter due to an ankle injury. On September 23, 2013, the Arizona Cardinals placed Acho on injured reserve after he was diagnosed with a broken left fibula and was scheduled to miss the remainder of the season. He finished the season with five solo tackles, a sack, and a forced fumble in three games and ten starts.

On October 21, 2012 Acho recorded four combined tackles, deflected a pass, and made his first career interception during a 21–14 loss at the Minnesota Vikings. Acho made his first career interception off a pass by Vikings' quarterback Christian Ponder, that was originally intended for running back Adrian Peterson, in the second quarter. In Week 14, he collected a season-high seven combined tackles in the Cardinals' 58–0 loss at the Seattle Seahawks. He started in all 16 games in 2012 and recorded a career-high 48 combined tackles (35 solo), four sacks, three pass deflections, and two interceptions.

Acho attended the NFL Scouting Combine in Indianapolis and performed all of the combine and positional drills. On March 29, 2011, he participated at Texas' pro day, but chose to stand on his combine numbers and only performed positional drills. At the conclusion of the pre-draft process, Acho was projected to be a second or third round pick by the majority of NFL draft experts and scouts. He was ranked as the seventh best outside linebacker in the draft by DraftScout.com.

The Arizona Cardinals selected Acho in the fourth round (103rd overall) of the 2011 NFL Draft. Acho was the 12th defensive end drafted in 2011.

On July 29, 2011, the Arizona Cardinals signed Acho to a four-year, $2.51 million contract that includes a signing bonus of $474,428.

He made his professional regular season debut in the Arizona Cardinals' season-opener against the Carolina Panthers and made his first career regular season tackle in their 28–21 victory. On October 23, 2011, Acho recorded two solo tackles and made his first career sack during a 32–20 loss against the Pittsburgh Steelers in Week 7. Acho sacked Steelers' quarterback Ben Roethlisberger for a five-yard loss in the fourth quarter. On October 30, 2011, Acho earned his first career start and recorded five combined tackles, a sack, and forced the first fumble of his career during a 30–27 loss at the Baltimore Ravens in Week 8. Acho forced a fumble while sacking quarterback Joe Flacco for a ten-yard loss in the third quarter. Acho remained the starting outside linebacker for the last ten games of the season after Joey Porter was placed on injured reserve due to a knee injury. In Week 10, he collected a season-high six solo tackles during a 21–17 win at the Philadelphia Eagles. He finished his rookie season in 2011 with 40 combined tackles (35 solo), seven sacks, two pass deflections, and four forced fumbles in 16 games and ten starts. Acho's seven sacks are the second most ever by a Cardinals rookie, trailing Simeon Rice’s 12.5 in 1996.

Acho's brother, Emmanuel Acho, also played football for Texas, where he was a consensus All Big 12 linebacker in 2011. Emmanuel was drafted by the Cleveland Browns in the sixth round of the 2012 NFL Draft and played four seasons with the Cleveland Browns, Philadelphia Eagles, and New York Giants. Emmanuel became an analyst for ESPN in 2017.

After his senior season in 2010, Acho was voted team MVP. He also won the William V. Campbell Trophy, given annually to college football's top scholar-athlete, as well as the Wuerffel Trophy, college football's premier award for outstanding community service, and was a finalist for the Lott Trophy. During his senior year, the Sporting News named Acho one of the 20 smartest athletes in sports, a list that included two other college players and 17 professionals from the four major American sports.

As a freshman at the University of Texas, Acho played in 11 games, recording six tackles and a sack. As a sophomore in 2008, he recorded 15 tackles and three sacks. As a junior in 2009, Acho started all 14 games and was named honorable mention All-Big 12 by The Associated Press after recording 55 tackles and eight sacks.

Samuel Onyedikachi Acho (born September 6, 1988) is an American football outside linebacker who is currently a free agent. He played college football at the University of Texas, and was selected by the Arizona Cardinals in the fourth round of the 2011 NFL Draft. He has also played for the Chicago Bears.