Doctor Compares Ricky Pearsall’s Rare PCL Surgery to Steven Adams’ 2023 Procedure

Ricky Pearsall’s knee injury just got a rare comparison — and it’s coming from outside the NFL entirely.

The San Francisco 49ers are deep into training camp as they build toward the 2026 season, but the biggest story out of Santa Clara this week has nothing to do with protecting Brock Purdy. It’s about the receiver they just lost for the year. Pearsall, San Francisco’s 2024 first-round pick, will undergo posterior cruciate ligament (PCL) reconstruction surgery that ends his 2026 season, general manager John Lynch announced August 1.

The injury traces back to Week 4 of the 2025 season, when Pearsall went down in a loss to Jacksonville. He tried to play through it, missing all or parts of ten games. The 49ers and their medical staff opted against surgery over the offseason, hoping rest would settle it. It didn’t. Pearsall was shut down after two practices in camp this summer because the knee kept swelling.

That’s an unusual injury path — and it’s what caught the attention of Dr. Prem Ramkumar, an orthopedic surgeon who spoke with the San Francisco Chronicle’s Eric Branch about how rare Pearsall’s exact procedure is. Isolated PCL surgeries aren’t common in professional sports. According to the Chronicle, Ramkumar could point to only one recent case that closely mirrors Pearsall’s situation: NBA center Steven Adams, who had surgery on an isolated PCL injury months after he first got hurt.

“Isolated PCL injuries do not typically require surgery,” Ramkumar said, per the Chronicle. “We usually operate when a patient has failed nonsurgical treatment for several months, if not years.”

That lines up with what happened to Adams. The Memphis Grizzlies center tore his PCL in January 2023, tried to rehab it without surgery, and ultimately had the operation that October when the non-surgical approach didn’t hold. He returned the following season. Pearsall’s path has followed a similar shape — get hurt, try to play or rehab through it, and only turn to surgery once it’s clear the knee isn’t stabilizing on its own.

The comparison matters because isolated PCL tears — ones that don’t involve damage to other ligaments — usually respond to bracing and physical therapy. Surgeons tend to reserve the knife for cases where the joint stays loose or unstable no matter how much rehab time passes. That’s the bucket Pearsall now falls into, and it’s part of why his recovery timeline sits in that wide six-to-12-month range rather than a tighter, more predictable window.

A Career Defined by Bad Breaks

Pearsall has had a brutal run of injury luck since San Francisco drafted him 31st overall in 2024. He missed most of his rookie training camp with a shoulder injury, then was shot during an attempted robbery near Union Square just before the season opener. He recovered from that and returned to catch 31 passes for 400 yards and three touchdowns in 11 games as a rookie — flashes of the deep threat the 49ers thought they were getting.

Last season brought the knee problem, and now it’s cost him the entire 2026 campaign before it started. In 20 career games, Pearsall has 67 catches for 928 yards and three touchdowns. The tools have shown up in stretches. The health hasn’t.

The 49ers didn’t wait around. Within hours of the Pearsall news breaking, San Francisco brought back Deebo Samuel on a one-year deal worth up to $7 million, reuniting him with the offense that helped send the 49ers to two Super Bowls during his first stint. Samuel spent 2025 with Washington, catching 72 passes for 727 yards and five touchdowns before returning to Kyle Shanahan’s system.

That leaves San Francisco’s receiver room built around Samuel, Mike Evans, Christian Kirk, rookie De’Zhaun Stribling and DeMarcus Robinson — a group with plenty of proven production, even without the ceiling Pearsall was chasing.

The Bigger Picture: Another Injury-Plagued Camp

This is a familiar problem in Santa Clara. San Francisco was hit hard by injuries throughout the 2025 season, with Brock Purdy, Fred Warner, Nick Bosa, and George Kittle all missing significant time. The team still clawed its way to the NFC divisional round before its season ended. Repeating that kind of run while missing another key piece won’t get easier.

San Francisco opens the 2026 season on September 10 against the Los Angeles Rams — a road divisional game played in Australia. Pearsall’s timeline puts a possible return somewhere in the nine-month range if his recovery mirrors the “sweet spot” doctors have described, which would put him back on track for 2027 rather than any part of this season.