49ers lead NFL in wounded knees on mend

SANTA CLARA - Dr. James Andrews isn’t astonished the 49ers have nine players - two shy of a full huddle - who are battling back from torn anterior cruciate ligaments.

As arguably the most renowned doctor in American sports, he’s seen it all, even a team coping with 13 ACL tears. No matter the number of patients, a common thread exists.

“Everyone wants to be ready for next season and get back in the line of fire,” Andrews said in a recent phone interview.

With organized team activities and minicamps starting this week, quick bursts, sudden stops and turn-on-a-dime cuts will test those surgically repaired knees.

“The success rate depends a lot more than on just the ACL itself,” Andrews said, referring to rehabilitation and recovery, both physically and mentally.

No other NFL team has more than four players coming off an ACL tear. The average is about two players per team, and only six rosters have no such comebacks in the works.

To get back into Super Bowl contention, no team needs triumphant comebacks as much as the 49ers, with linebacker NaVorro Bowman’s chief among them.

“I’d say we’re more treating Bow like a vet than we are treating Bow like a post-injury guy,” coach Jim Tomsula said Friday. “We go straight off what the trainers and sports medicine guys recommend, and obviously converse with the guys to see how they’re feeling.”

No-contact drills in OTAs don’t come without risk. Since 2011, nearly one in four ACL tears occurred in practice (61 of 224), according to NFL research.

“You have ACL (tears) because there are high-speed practices with big guys putting torque on their knee,” said Dr. David Chao, the San Diego Chargers physician from 1997-2013. “A walk-through becomes a run-through, and that high intensity is how you get a foot caught (in grass) and tear an ACL.”

The 49ers will continue to exercise caution. Sharing that prescription is former 49er Chris Culliver, who missed 2013 with an ACL tear and parlayed his 2014 comeback into a free-agent payday with Washington.

“It’s a building block. You’re not going to get back and think you’re Superman,” Culliver said of OTAs. “You have to keep building so the knee gets better through practice. You can’t go 1,000 mph.”

Stark reminders of practice-field pitfalls came recently when two teams saw rookies rip their ACLs: the Jacksonville Jaguars’ Dante Fowler (No. 3 overall pick) and the Denver Broncos’ Jeff Heuerman (third round). It was also reported Thursday that Broncos Pro Bowl left tackle Ryan Clady tore his left ACL during practice on Wednesday.

Running back Kendall Hunter, wide receiver Chuck Jacobs, guard Brandon Thomas, cornerback Keith Reaser and fullback Trey Millard also missed last season due to ACL reconstruction. Outside linebacker Chase Thomas tore his right ACL before the offseason program began in April, and he’s rehabbing on the reserve/non-football-injury list.

“A lot of us have worked together and motivated each other to get back on the field,” Hunter said.

It’s been 15 months since Bowman’s left knee reached Dr. Andrews’ operating table. Bowman sustained a torn ACL and medial collateral ligament in the 49ers’ 2013 NFC Championship game loss at Seattle.

Andrews confirmed that Bowman’s was a “complex injury,” as opposed to an isolated ACL tear, which are most common and occur in non-contact action.

“Multiple ligament tears are more complex and take longer to come back from,” said Andrews, who was not at liberty to discuss Bowman’s progress nor any other of his 49ers patients, including defensive lineman Darnell Dockett and Reaser. (Both the 49ers’ lead orthopedist, Dr. Tim McAdams, and head trainer, Jeff Ferguson, declined interview requests for this story.)

Baalke, after using three draft picks last year on ACL-recovering prospects, hedged that gamble on his staff’s analysis of those players’ mindset.

“You try to look at the intangibles, look at the wiring, look at their work ethic, look at their mental toughness,” Baalke said, “and you bet on where you think those guys are going to take themselves post-injury.”