Why is this the most important question?

Because a healthy McCaffrey is almost a guarantee of a top-three fantasy running back. But an injured “CMC,” at the cost of a first-round selection, can destroy your hopes of a championship trophy right from the start.

So let’s get to analyzing what to do about McCaffrey.

As you can see in the first table, when he’s good… he’s very, very good. His 2019 and the start of the 2020 season rank among the best ever. Better than the best Todd Gurley seasons. In fact, they were almost as good as the famous 2006 season of LaDainian Tomlinson when The Chargers’ great rushed for 1,815 yards, caught 56 balls, scored 31 times and even threw two touchdown passes for a 29.6 FPts/G average. Yes, as Tony the Tiger would say - when CMC is good… he’s Grrrrreat!

In 2020, he started the season right where he left off, producing 90.3 fantasy points in the first three games. Then disaster struck and CMC didn’t play another game that season due to multiple injuries.

Still, fantasy owners assumed it was a one-time fluke issue and the Panthers’ running back was still a top selection on Draft Day 2021. He started off strong, averaging 26.2 against the Jets and Saints, but again lightning struck early in Week 3. He wouldn’t play until Week 9, averaged 25.5 FPts/G in Weeks 10 and 11 and then in Week 12 was once again back on the sidelines and didn’t play another down.

First let’s look at the type of injuries he suffered. Were they possibly career-ending? Did they require major surgery? Does he suffer the same injury over and over again? The answers are; no, no and no.

In 2020 he suffered a right ankle sprain, a right shoulder AC joint sprain and a thigh injury. No surgeries were needed. The following season it was a right hamstring injury and a left ankle injury. Again, no surgery needed and none was a repeat injury.

Traded to San Francisco in the middle of 2022, McCaffrey played 33 of 34 games over the next two seasons and played well, though not to the historic levels he had produced in 2019. He was on a better team with the 49ers, so much more offensive talent and they didn’t need him to be the “one-man band” he was in Carolina. They had Deebo Samuel and Brandon Aiyuk at wideout and George Kittle at tight end. Slightly better than in Carolina where the offensive coordinator’s options were; D.J. Moore, Curtis Samuel and an aging Greg Olsen.

But here we are again, in the summer of 2025, wondering if a now 29-year-old McCaffrey can return from more injuries. This time it was eight games to start the season due to Achilles tendonitis and five games with a knee injury. The Achilles injury is the worrisome one. Guys now return from knee injuries in less than a year, but Achilles injuries can be life-changing. Sometimes they come back, and sometimes they come back but never at the same production level. Some recent Achilles injuries to Arian Foster, James Robinson, Tarik Cohen, Marlon Mack and Cam Akers haven’t turned out particularly well, though they had tears not tendonitis.

In late April, McCaffrey spoke to reporters and said he was “feeling good” and has no “health-related restrictions” heading into this summer’s training camp.

But can we trust those words? He and the 49ers hid the severity of his Achilles injury last pre-season and let fantasy owners unknowingly draft an injured player with a top-three pick. I’m the cynical type and after being burned once, I’m loath to trust their words with blind faith.

They are going to have to show me he can play before I use a top-three pick on him. Because if he’s healthy, he still is a top-three pick. Maybe not Saquon Barkley or Jahmyr Gibbs good, but 22 FPts/G (what he averaged in 2022-23) would still be top-three worthy.

However, he’s going to have to at least play a few downs in pre-season. Or look good on the field in practice and not sit on the sidelines and tell me he’s “fine.” I’m going to need to see it with my own eyes. Because if I draft him early in the first round, the best he can do, his ceiling is, “as expected.”

On the other hand, his July ADP is 11.8 and choosing him at the end of the first round or early second round leaves some wiggle room. I’m no longer comparing him to Saquon and Jahmyr, I’m comparing him to an untested rookie, Ashton Jeanty (ADP 12.9) and De’Von Achane (14.7) if I want a running back. Or Brian Thomas Jr. (ADP 12.3) or Drake London (14.1) if I want an available receiver. Comparing these options, I can easily make the recommendation that a healthy CMC is better than those four choices.

Below, in the second table, are the four players being selected right behind McCaffrey. You can make the case that McCaffrey is better than all of them. Because in 2025, the 49ers’ offense needs him more than ever. Deebo is gone (Washington). Aiyuk (knee) probably won’t be back until a month into the season. CMC’s backup, Isaac Guerendo, had a couple of decent games last season, but is still basically untested. Kittle will be 32-years-old in October. Yes, a healthy McCaffrey should be a huge bargain at ADP 11.8.

However, I’m not drafting him until he SHOWS me he is healthy… not just tells me. If he and the team hide him all pre-season, I’m not drafting him.

Bottom line - If you know he starts the season healthy, there is no question, you choose him at his current ADP.