Could 49ers LB Fred Warner return for playoffs? Unlikely, but surgeons see one scenario – The Athletic
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SANTA CLARA, Calif. — Could Fred Warner return to the San Francisco 49ers’ lineup this season? Maybe if they make the Super Bowl.
That was the assessment of two Northern California orthopedic surgeons, who put a typical recovery from an ankle fracture and dislocation like Warner suffered at four months but noted that variables — both positive and negative — could affect the timeline.
Coach Kyle Shanahan said Wednesday that Warner’s surgery, performed locally on Tuesday, went “great” but that there’s no firm estimate for his recovery. He previously said he did not expect Warner back this season.
“I’m not thinking about that right now,” he said when asked if Warner could return if the 49ers make the playoffs.
Dr. Eric Giza, chief of orthopedic foot and ankle surgery at UC Davis and head physician for the Sacramento Republic FC soccer team, usually gives patients with similar injuries a 6-6-4 recovery timeline, he said. It will take six weeks for the ankle to heal, another six weeks of rehabilitation and four weeks of what he called restoration.
“At 12 weeks, you’re rehabbed and you’re ready to start fully training, and it takes four weeks to fully restore yourself,” Giza said.
Giza, however, noted that professional athletes have access to treatment and technology a weekend pickleballer might not have. Warner could use underwater treadmills or so-called antigravity treadmills to begin rehabilitation sooner than normal. The antigravity treadmills use a pressurized air chamber to support an athlete’s body and can “unweight” up to 80 percent of the patient’s body weight.
“It’s a little different than sitting on your couch with a cast on,” Giza said.
Because of that, some athletes start training sooner than normal and can beat the usual timeline.
Giza and Dr. Dan Solomon, an orthopedic surgeon with MarinHealth UCSF Orthopedics, cautioned that they’re not privy to the specifics of Warner’s injury and were speaking on general terms.
Solomon said a recovery can take longer if the syndesmosis ligament, which runs between the tibia and fibula, is torn. He said that’s the ligament that’s typically involved in high-ankle sprains.
“Those can be notoriously difficult and take quite a bit longer than three months to rehab and recover,” Solomon said. “It’s a ligament that’s important for ankle stability. For any pro athlete, there’s a lot of movement, rotation, strain on the ligament. You really have to make sure that’s recovered so it doesn’t recur or he doesn’t have future ankle instability issues.”
There’s also the possibility of a follow-up surgery, something former 49ers quarterback Trey Lance had in 2022 after he fractured and dislocated his ankle in Week 2. Lance had a second procedure in late December to remove a bothersome screw. About one in eight patients elects to remove hardware after the ankle surgery, oftentimes because the screw protrudes from the bone.
“Some of them have irritation,” Giza said. “Because they have their cleats on so tight. Sometimes they have a screw removed. Some will get pain from scarring, and during the offseason, we take them back for arthroscopic surgery to clean out the scar tissue.”
Solomon said sometimes the injury will also cause cartilage damage, which can require a lengthier follow-up procedure to help fill in that cartilage.
Said Giza: “Bottom line is, unless the 49ers go to the Super Bowl, (Warner) is probably out for the season.”
