Grant Cohn: 49ers’ thinking flawed in drafting all those torn ACLs

“Trent Baalke is an idiot for drafting guys with ACL problems.”

That was the first thing Dr. Gary Furness, a family physician in Santa Rosa with a background in sports medicine, said to me on the phone Tuesday evening.

The day before, Monday, the Niners had placed on the Injured Reserve list rookie third-round pick Will Redmond, a cornerback who tore his ACL his final season in college. In addition, the team released 2015 fourth-round pick DeAndre Smelter, a wide receiver who also tore his ACL his final season in college.

Since 2013, Niners general manager Trent Baalke has drafted seven players with torn ACLs - far more than any other general manager during this period. Of those seven players, one was a second-round pick (Tank Carradine), two were third-round picks (Redmond and Brandon Thomas), two were fourth-round picks (Smelter and Marcus Lattmore), one was a fifth-round pick (Keith Reaser), and one was a seventh-round pick (Trey Millard).

Only Carradine and Reaser are still on the team.

Baalke probably thinks he can draft a player with a torn ACL in the mid rounds who was supposed to be an early round selection. From that standpoint, Baalke’s picks look like ‘steals.’

“But it’s like he’s stealing a bag of flour with a hole in it that’s leaking as he’s leaving the store,” the doctor said. “He’s really taking a huge risk. Spending even a mid-round pick on a player with a torn ACL is just nuts. Nobody can predict if that player will succeed after an ACL tear.

“You can know if he will fail. You can see the deficits in his cartilage. But it’s impossible to tell if the athlete will be lucky enough to make it back.”

Now, I present to you Furness uninterrupted. Pay close attention to what he says. That means you, too, Trent.

“A large percentage of players who tear their ACLs - 20 to 30 percent - never return to playing football. That’s a pretty high number.

“The 70 to 80 percent who do return are not as good as they were before, and their careers are much shorter. Two to three years shorter. And almost always they’re going to be less productive. The Adrian Petersons of the world really are the exception rather than the rule.

“The ‘in’ way to repair an ACL several years ago was with a hamstring graft that you take from the athlete himself. That’s called an ‘autograft.’ It has been shown to be a horrible mistake. It’s not stable. The failure rate is closer to 50 percent, and the hamstring you’re taking away from won’t be strong, either.

“That procedure has been replaced by what is called an ‘allograft,’ where you take the graft from a cadaver. That seems to have the highest chance of success, but it still is far from 100 percent.

“I’m not an orthopedic surgeon, but when you repair the ACL even under the best circumstances, there are several things at play. Just looking at a completely isolated ACL repair, the angle that the artificial ACL ligament is placed at is not the same as what Mother Nature intended.

“So there is no such thing as a perfect repair. Even in an ideal circumstance where the surgeon does everything as meticulously as humanly possible, that ACL is not going to work at the same mechanical advantage that it did before it ruptured.

“Plus, there is usually other damage. Damage to the cartilage. Damage to the meniscus. Damage to the MCL. Those things are usually not repairable. So when you consider all of those faults along with the actual surgical failures, that’s where your 20 to 30 percent outright failure to become a competitive athlete comes in.

“And even if an athlete suffers a “clean” ACL tear with no extra damage to his knee, he still faces a significant rate of failure.

“Orthopedic surgeons are starting to realize they probably have overestimated their ability to fix these players. Every orthopedic surgeon’s sample size is so small, they have a tendency to think their success rate is higher than it really is. You can have a Stanford orthopedic surgeon who theoretically goes 10 for 10. But in the big scheme of things, that number is pretty meaningless. He could easily go 5 for 10 the next time.

“And there’s this dirty secret: Someone who tears one ACL is at a much, much higher risk of tearing the other ACL. Usually it’s because they have an anatomy that predisposes them to the rupture. The notch in the femur tends to be narrower and rather sharp. If you’re trying to do the same thing that led to the first ACL tear, chances are it could lead to a second ACL tear.”

Finally, I interrupted. “Gary, if Baalke called you and asked if you would recommend him ever spending a draft pick on a player with a torn ACL, what would you tell him?

“My answer would be ‘no.’”

Grant Cohn writes sports columns and the “Inside the 49ers” blog for The Press Democrat’s website. You can reach him at grantcohn@gmail.com.