SANTA CLARA -- Wearing a hospital gown, a surgical cap and a look of defiance, 49ers linebacker NaVorro Bowman on Tuesday took a cellphone selfie and captioned it on Instagram: Time for surgery.
The procedure to repair Bowmans left ACL was performed Tuesday in Pensacola, Fla., by Dr. James Andrews, who has handled some of the NFLs most high-profile surgeries in recent years, including ACL repairs for Minnesota Vikings running back Adrian Peterson late in 2011 and Washington Redskins quarterback Robert Griffin III early last year.
Andrews has been consulting with the 49ers medical staff, and a member of that group was in Florida to observe the procedure.
Bowmans gruesome injury it was replayed on TV over and over because he forced a fumble on the play occurred in the second half of the NFC Championship Game when Seattle Seahawks receiver Jermaine Kearse was driven into Bowmans planted left leg. Bowman was diagnosed with tears to his MCL and ACL.
Other orthopedic surgeons said that despite two ligament tears, Bowmans prognosis is very good and he can expect to be back on the field in six to eight months. The regular season starts in seven months.
Bowman was the 49ers best defensive player in 2013, leading the team in tackles, earning Pro Bowl and All-Pro honors and winning the 49ers most prestigious team award. While some players most notably Peterson have returned to their previous form the following season, doctors cautioned that others have not, at least not right away.
Ill typically tell my players that we may let you go back to play somewhere in the six- to eight-month period, but its often a year before you feel normal again, said Dr. Matthew Matava, the St. Louis Rams team doctor and president of the National Football League Physicians Society. And it seems like every time you do that, theyll say, Yeah, youre right. Its taken me a year before I felt normal.
There were two reasons to wait 17 days before performing the surgery. The first was to give the MCL a chance to heal on its own. Unlike the ACL, the MCL gets a good supply of blood and usually does not need to be surgically repaired. Offensive linemen Joe Staley and Mike Iupati and fullback Will Tukuafu of the 49ers suffered MCL tears this past season, and the injuries healed without surgery.
Matava said even in the rare instances when the MCL does require surgery, the prognosis is still good. He said Bowmans outcome likely will be dictated by the ACL injury, not the MCL.
Another reason for waiting was there is significantly more trauma to the knee joint when the MCL is involved than when its solely an ACL tear. Before surgery can occur, doctors must allow swelling in the knee to dissipate to make the muscles around the knee as strong as possible and for Bowman to regain his range of motion in the joint.
You really want to prevent stiffness before you do your ACL surgery, said UC Davis Dr. Eric Giza, an orthopedic surgeon for the U.S. Soccer Federation. If youre too aggressive and they can only bend their knee 90 degrees, theyre never going to be able to bend beyond that. Obviously, for a professional athlete, that ends your career.
In that way, Bowman already has begun his rehabilitation.
Before flying to Florida over the weekend, he was at the 49ers facility every day since the injury. Giza surmised the linebacker has been doing pool therapy, has been on a stationary bike and has had an electrostimulation device attached to his quadriceps to keep the muscle strong.
Giza said he wouldnt be surprised if the 49ers outfitted him with a special sleeve that circulates cold water over the knee and regulates pressure, both of which help reduce swelling and stiffness.
They probably had that thing on him within minutes, he said. It costs about $7,000, so the average bear doesnt have them. But these guys do.
Finally, waiting on surgery gives the patient time to get into a mental state where hes ready to tackle the operation and the subsequent arduous rehabilitation.
One of the best ACL comebacks in recent years was made by Peterson, who tore ACL and MCL ligaments Dec. 24, 2011. He started all 16 games the following season, finished with 2,097 rushing yards second most in a season and was named Offensive Player of the Year and the leagues MVP.
Still, the procedure and rehabilitation arent foolproof, and recovery can be dramatically different from patient to patient.
Griffin, for example, was not the same player in 2013 that he was a year earlier, when he was named Offensive Rookie of the Year, and he was shut down for the Redskins final three games in 2013. Three 49ers, meanwhile, suffered ACL injuries in 2012. Two of them, linebacker Darius Fleming and wide receiver Kyle Williams, retore the ligament the following season. A third player, wide receiver Mario Manningham, never returned to full strength in 2013 and was placed on injured reserve, which ended his season.
Do they get back? Yeah, theres a very high return rate, Giza said. Do they all perform at the same level? Do they come back and break NFL records afterward? I dont know if we have enough information to say one way or another.
Read Matthew Barrows blogs and archives at www.sacbee.com/sf49ers and listen for his reports Tuesdays on ESPN Radio 1320.