Anyone who witnessed Na Vorro Bowman’s injury live on TV was quivering for a while. Many adults remember where we were when Joe Theisman hit and broke his tibia. This injury looked brutal. My immediate diagnosis was that Bowman had torn his ACL and his MCL. Most Orthopedists would have agreed.
Injuries that involve more than one ligament are far more complex than injuries that involve only the anterior cruciate ligament or the medial collateral ligament in isolation. The treatment of these multi-ligament injuries is complex and has evolved over time.
The 49ers feared that linebacker NaVorro Bowman injured both his ACL and MCL against the Seahawks on Sunday and those fears have been realized.
Most people understand that an isolated ACL injury is followed by a course of therapy to resolve your stiffness and prepare your knee for a potential surgical repair.
For patients with an isolated MCL or medial collateral ligament tear, the treatment will vary depending on the “grade” of the tear. MCL tears are graded as complete or partial. Partial tears will almost always heal with time, bracing and physical therapy. Complete tears of the MCL generally require an open repair of the MCL followed by a period of bracing and then physical therapy.
ACL and MCL Combined Injuries
When both the ACL and the MCL are torn, the timing of treatment is critical. The MCL, if it is a complete tear needs to be repaired soon after the injury. Otherwise, the ligament will scar and shorten making a repair difficult… threatening the overall result. Once the ligament is repaired, and once the athlete has recovered, they are then looking at an additional surgery to reconstruct the ACL. While this is a long recovery process many people do very well if the injuries are managed in a timely manner. Whether or not Bowman can return to professional sports is an open ended question. Not all professionals can return after an isolated ACL tear. It is possible, but time will tell.