Purdy's UCL injury: Why repair, quicker rehab is more likely than Tommy John
Brock Purdy's elbow injury brought the 49ers' Super Bowl LVII hopes crashing down, and the stillunknown severity of his ligament tear could go a long way toward determining their chances of reaching next February's edition.
Purdy will need surgery to repair his ulnar collateral ligament, and the 49ers are optimistic Purdy's path to recovery could take only six months.
Former 49ers backup Nick Mullens is the lone NFL quarterback known to have a torn ulnar collateral ligament repaired with an internal brace. That came after an injury he sustained in the 49ers' penultimate game of the 2020 season.
Mullens' comeback tour has taken him to four teams — the Browns, Eagles, Raiders and Vikings — over the past two years.
Purdy continued to seek medical opinions the first few days after his openingseries injury on Sunday, and the consistent feedback is that the 23-year-old likely will undergo a repair, general manager John Lynch said Wednesday. However, a UCL replacement, also known as Tommy John surgery, can't be completely ruled out yet.
The ultimate decision could come mid-operation when the surgeon can closely examine the ligament.
“The positive bit of news is that it seems to be consistent that the right approach is the one that takes us to the six-month mark,” Lynch said.
“Everyone will also say, you never know once you get in there. Every surgeon will tell you that on every surgery, you need to get in to see exactly.”
Dr. Nirav Pandya, a pediatric orthopedic surgeon at UCSF, isn't surprised by this diagnosis.
That Purdy was gingerly throwing the football on the sideline — and later able to throw a handful of wobbly emergency passes once backup Josh Johnson left the game with a concussion — is a good indication that Purdy's UCL is in decent shape despite the tear. Pandya said he would be shocked if surgeons determined that Purdy needed a UCL replacement.
“He has so much less mileage on his elbow, so that works in his favor,” Pandya said. “He probably has good cartilage and muscles. It's never a good time for surgery, but the fact it's during his first year is a good sign.”
If Purdy undergoes a repair, he will likely be able to start throwing a ball again after three months and return to action after six months, “so you have May to August to get back to your mechanics and iron out details,” Pandya said.
Mullens, when reached by the Bay Area News Group, preferred not to detail his surgery or recovery, but did state: “The UCL repair internal brace surgery allowed me to get back on the field faster than Tommy John surgery. I couldn't afford to miss a whole year with Tommy John so I'm thankful for the internal brace.”
CRISIS AVERTED >> Surgery is never ideal, but the 49ers have to be relieved by what they're hearing.
Tommy John surgery would force Purdy out for 9-to-12 months, but it is common among athletes with far more wear and tear on their elbows.
Baseball pitchers, including the eponymous Tommy John himself, have typically needed the surgery because they use that ligament to get torque on their pitches, repeatedly thrown at high velocity. Jake Delhomme, formerly of the Panthers, is the only NFL quarterback known to have had Tommy John surgery, and he had a record of elbow pain and injuries.
A UCL repair is far less invasive and would give Purdy plenty of time to rehab his elbow in time for the 2023 season. He and Trey Lance will likely be competing for the starting quarterback job, coach Kyle Shanahan told reporters on Wednesday.
“I know we have two starters on our team right now that I believe we can win with,” Shanahan said. “So when you have that situation, you're not that eager to go looking around.” MULLENS' CASE STUDY >> Mullens said he hopes Purdy's recovery “turns out the same” as his own, adding that it was “fun to watch” Purdy produce eight wins in relief of Garoppolo. Mullens came off the 49ers' bench in 2018 after injuries to Garoppolo and C.J. Beathard, winning three of his first six starts.
After tearing his UCL on Dec. 20, 2020 in a 49ers loss at Dallas, Mullens was throwing by March 2021, under the guidance of physical therapist Dr. Kevin Wilk of Champion Sports Medicine in Birmingham, Alabama.
Mullens landed a spot in the Eagles' 2021 training camp, and they released him after a rocky preseason (16-of-29, three interceptions). The Browns added him to their practice squad, until he was summoned as a COVID replacement starter in a late-season loss to the Las Vegas Raiders, in which he threw a go-ahead touchdown in the fourth quarter.
Mullens joined the Raiders last year, then was traded to the Vikings, where he served this season as Kirk Cousins' backup. Mullens made four appearances (21-of-24, 224 yards, one touchdown, one interception), and he played the second half of their triumphant regular-season finale at Chicago, which forced the 49ers to win their respective game to secure the NFC'S No. 2 seed.
Mullens is slated to become a free agent next month. The 49ers will need to add two to three quarterbacks for their offseason program, and while Lynch and coach Kyle Shanahan suggested they won't seek a high-profile veteran, perhaps Mullens' experience in both the Shanahan system and elbow recovery could make him appealing. POST-SURGERY RISK? >> Though the recovery time following a repair isn't extensive, there are some concerns to watch for once Purdy returns. Will Purdy feel a little rushed in order to avoid contact on his surgically repaired elbow? Will any lingering soreness impact his play? Will he compensate for any soreness, leaving him vulnerable to injury?
Those are all risks to consider, but the odds that he will have recurring issues with his elbow are low, Pandya says.
“For a repair, because he won't be stressing it, there's a low likelihood he would have recurring issues,” he said. “(It's a) better quality tissue — he's not throwing 100 mph fastballs, so all things are in his favor.”
While an MLB pitcher is activating his UCL on almost every pitch, the quarterback does not use that part of his elbow when throwing. So chances that Purdy would aggravate the ligament injury are slim.
“The throwing motion is a little different (than a pitcher): You aren't straining the UCL as much,” Pandya said. “The football is bigger and (there's) less torque across the elbow. You see muscle issues around the elbow with quarterbacks, but you don't see the ligament take a hit.”
The bad luck of Purdy's injury was the timing and placement. It happened on the 49ers' first drive of the game when Eagles linebacker Haason Reddick hit Purdy in the arm as he was attempting to wind up and throw.
“People get hit all the time in the arm,” Pandya said. “He's throwing at the right motion where if someone were to hit him, it will strain the UCL. If he hit him two seconds later, he probably would have been fine.”