NaVorro Bowman injury: A look at why his post surgical ACL/MCL prognosis is excellent

Jonathan Ferrey

49ers linebacker NaVorro Bowman tore his ACL in the NFC Championship Game, and suffered additional damage to his MCL. We look at why Bowman's surgery was delayed and why there is an excellent prognosis of full recovery.

San Francisco 49ers linebacker NaVorro Bowman suffered a brutal injury in the NFC Championship Game, caused when Jermaine Kease was driven into Bowman's planted left leg. The initial diagnosis of his left knee were tears to his MCL and ACL. Subsequent reports indicated the tear to the MCL did not require surgery, and doctors stated they would wait for the swelling of the MCL to subside before attempting surgery on the ACL.

The MCL extends from the end of the thigh bone to the top of the shin bone on the inside of the knee. Although tears to the MCL are common in sports, most MCL injuries respond well to conservative (non-surgical) treatment. The MCL gets more blood supply than other ligaments, like the ACL/PCL in the knee. Increased blood flow means more nutrients, proteins and oxygen to the area. Simply put, MCL tears heal quicker due to the nature and location of the ligament.

You may recall Mike Iupati and LaMichael James both suffered grade II tears to the MCL in 2013. Both were out four to five weeks due to the injury. Even if Bowman suffered a grade III tear, because of the good blood flow to the ligament -- it is very rare a torn MCL requires surgery. By the look of the brutal impact Bowman took to the outside of the knee, my first inclination was this may indeed be one of those instances. However, when reports indicated Bowman did not need surgery for his MCL, I was very hopeful about Bowman's prognosis.

There are four ligaments that run inside your knee. Each ligament serves the purpose of stability. If a person sustains an injury to one ligament, he has the stability of three other ligaments to support the weak ligament. With three quarters of the knee stable, Bowman can focus fully on rehabilitation of the ACL.

Early this past Tuesday, NaVorro Bowman posted a picture to Instagram awaiting surgery on his torn ACL. All reports indicate the surgery went well. Waiting two weeks before undergoing surgery on the ACL allows swelling and stiffness to subside, and it allows the MCL to repair on its own.

In reporting on the injury, Matt Barrows wrote that Bowman had spent the previous two weeks rehabbing at the team facility, keeping the knee loose and flexible. This kind of work helps strengthen the areas around the ACL. His quad and calf areas will suffer some degree of atrophy after the surgery because he will not be able to use it immediately. The stronger those areas are heading into surgery, the better for his recovery.

Barrows indicated Bowman's surgery was performed in Florida by renowned surgeon James Andrews. Dr. Andrews has worked on a number of high-profile clients, with some notable recoveries.

Although Bowman was swindled for defensive player of the year, most of us realize what kind of impact he had on the 49ers defense this season. With Aldon Smith absent five games, and Patrick Willis missing a pair of games with a serious own groin injury, Bowman kept up the pace for the 49ers defense. Very shorthanded, Bowman recorded 145 tackles and 5 sacks. He forced four fumbles and had two interceptions, including his 89-yard interception return for a touchdown. That play was the perfect storybook ending to my memories at Candlestick Park.

I am not exactly sure what it is about Bowman's injury that pulls at me. Injuries are routine, but when he went down -- I almost did not care about winning. And, I really wanted the 49ers to win that game.

If there is any player that deserves to come back better, stronger and faster, it would be NaVorro Bowman. Several believe he will likely begin on the PUP, possibly return sometime in week 6. While it is a scenario, I think Bowman's durability is second to none. If there is any player who can beat the odds and shatter medical baselines, it would be him. While there are no guarantees, it is very likely Bowman will see a full recovery within the projected 6 to 8 month time frame.

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