The Gruesome Knee Injury for San Francisco 49er NaVorro Bowman

The words “ACL tear” are notorious with sports fans who see this as a season-ending injury for their favorite athletes. The San Francisco 49ers’ stellar inside linebacker, NaVorro Bowman, suffered a gruesome knee injury on Sunday as fans gasped from their stadium seats or their sofas, watching his knee bend in seemingly opposite directions.

NaVorro’s injury affects two ligaments: the ACL and MCL. These are abbreviations for Anterior Cruciate Ligament (ACL) and Medial Cruciate Ligament (MCL). The ACL is a major stabilizer of the knee when cutting, running, jumping, and even going up and down stairs. The MCL is responsible for providing additional support side to side when performing the same activities. The combination of those two ligaments being stretched beyond their capacity created the visual of the football star’s knee being bent in two directions.

When ACL tears occur, some people hear and feel a strong pop in their knee. If forcefully combined with another ligament, such as in Bowman’s case, then the knee drastically “gives out.” Clinical testing such as an MRI typically confirms the diagnosis. Some people can rehabilitate a tear without surgery if they are returning to low-level activities throughout the day. In Bowman’s case, his physical requirement is extreme and his injury will require surgical repair along with intensive physical therapy afterwards.

ACL surgery typically consists of taking a tendon from another part of the leg and connecting it in place of the torn ligament. At times, surgeons will prefer to use a graft from a cadaver to replace the ligament. The incisions are small and barely noticeable once healed. The MCL oftentimes heals on its own with the use of a brace; however, many times the surgeon will perform some type of reconnection of that ligament if she or he is already inside the leg for the ACL repair.

After surgery, there is significant swelling and bruising. A brace locking the knee straight is typically used to help keep the knee from bending and pulling at the newly constructed ligament. Crutches are used to help take weight off, although most people can bear weight almost immediately.

The formal rehabilitation for this injury starts within the first week after surgery. It is a lengthy rehabilitative process, but important for restoring the same level of athletic function and speed. A minimum for this rehab is three months, whether it is an athlete or not. Oftentimes the rehab is closer to four to six months, depending on how quickly strength and agility can be regained.

The first phase of rehab focuses on range of motion, normal walking, swelling control, and getting the knee muscles to contract. The second phase focuses on extensive strengthening and the third phase is a return to sports or pre-injury function.

Most surgeons clear an athlete back to sport at four months after a series of sports-specific tests have been performed. At this point, Bowman has a long road ahead of him, but he’s expected to be back on the field with his team in the fall.

(Sports PT of NY treats ACL pre- and postoperative ACL injuries. For an appointment, please visit us at