Between Shohei Ohtani, Félix Bautista, and now Tony Gonsolin, the fragility of ulnar collateral ligaments has been an all-too-frequent matter of dialog throughout the previous week. Gonsolin, in case you haven’t heard, is headed for Tommy John surgical procedure on Friday, whereas we’re nonetheless ready to listen to whether or not the UCL accidents of Ohtani and Bautista are important sufficient to advantage going beneath the knife. Between that trio and the Rays’ Shane McClanahan taking place earlier this month — and the truth that neither Gonsolin nor McClanahan are the primary members of their groups’ rotations this 12 months to want such surgical procedure — it definitely feels as if we’re coping with a whole lot of Tommy Johns these days, so it’s value slicing by way of the numbers.
First, nonetheless, let’s spare just a few paragraphs for Gonsolin and the Dodgers. The 29-year-old righty was coming off an All-Star season wherein he posted a 2.14 ERA and three.28 FIP in 130.1 innings, and owned equally spectacular profession marks (2.51 ERA, 3.45 FIP) regardless of his intermittent availability because of accidents, which included a six-week absence close to the tip of final season because of a forearm pressure, and simply two appearances totaling 3.1 innings afterwards, one in every of them a four-out begin within the 2022 Division Sequence. After spraining his left ankle throughout fielding drills in early March, he was taking part in catch-up and by no means appeared to discover a consolation zone. He started the common season on the injured listing, lastly debuting on April 26, and whereas his run prevention numbers regarded good within the early going, his peripherals instructed one other story, and his common fastball velocity was down. On June 11, supervisor Dave Roberts alluded to some well being points with Gonsolin, noting that his between-starts restoration “hasn’t been nice,” and questioning if he was having hassle getting free or pacing himself. In his subsequent begin two days later, Gonsolin threw six shutout innings however averaged simply 91.1 mph along with his four-seamer, two full ticks beneath final 12 months.
To that time, Gonsolin had a 1.93 ERA however a 4.25 FIP, and shortly he started to get roughed up on a routine foundation. Over his subsequent seven begins, he allowed 4 or extra runs six instances, producing a 7.25 ERA. Following a 3.1-inning, five-homer, 10-run stinker on August 18, Gonsolin’s second unhealthy begin out of three, Roberts instructed reporters that Gonsolin had been pitching by way of an unspecified “arm difficulty” for 4 to 6 weeks and would doubtless head to the injured listing. On Sunday, the Dodgers acknowledged that surgical procedure was an choice, and on Monday it was revealed he’d endure Tommy John on September 1.
Gonsolin had apparently been pitching by way of a UCL tear, one thing he and the Dodgers knew primarily based on imaging achieved after that June 13 begin. Conscious of the concurrent losses of Dustin Could and Julio Urías to the IL, Gonsolin elected to pitch by way of the harm. “I used to be simply hoping I might make it by way of the season, put up good numbers and simply put up,” he instructed reporters. “I believed I had full functionality to do this.”
Gonsolin did have monetary incentives to intestine it out, and the Dodgers let him accomplish that. Through the two-year, $6.65 million extension he signed in January, he earned one level for each begin or aid look of not less than 3.1 innings. For reaching 14 factors, he added $500,000 to subsequent 12 months’s base wage of $3.4 million, with extra will increase of $500,000 apiece for reaching 16, 18, 20, 24, and 28 factors. That 3.1-inning shellacking acquired him to twenty factors, that means that he’ll make $5.4 million subsequent season whereas rehabbing after surgical procedure. He’ll have two years of membership management remaining after that.
With Could out because of his personal Tommy John surgical procedure — his second, alas — the lack of Gonsolin leaves the Dodgers with a rotation of Urías, Clayton Kershaw, Lance Lynn, and rookies Bobby Miller and Ryan Pepiot. Kershaw continues to be constructing his pitch rely again up following a six-week absence because of shoulder soreness. Urías has not had his sometimes robust season, posting a 4.41 ERA and 4.43 FIP. Lynn has improved significantly since being acquired from the White Sox on the commerce deadline, utilizing a brand new pitch combine to put up a 2.03 ERA in 5 begins for Los Angeles in comparison with a 6.47 mark for Chicago. Miller, the crew’s high pitching prospect, has been dazzling at instances however has additionally spiraled his approach into large innings; he has a 4.00 ERA and three.64 FIP. Pepiot has solely pitched 3 times for the Dodgers this season after lacking all the first 4 and a half months because of an indirect pressure; Wednesday evening’s begin towards the Diamondbacks was his first main league begin since final August 21. Deadline acquisition Ryan Yarbrough is a bulk different, whereas Gavin Stone and Emmet Sheehan are again at Triple-A Oklahoma Metropolis after taking their lumps for the Dodgers. Walker Buehler, who’s rehabbing his approach again from his second Tommy John surgical procedure, has but to throw greater than an inning at a time on the Dodgers’ coaching complicated, and isn’t prone to be constructed as much as a starter workload by the point the playoffs roll round.
Except Urías recovers his type, that doesn’t precisely appear like the makings of an imposing postseason rotation. The even greater query is what occurs subsequent 12 months provided that he, Kershaw, and Lynn are all poised without spending a dime company, although the final of these pitchers has an $18 million choice. The Dodgers ought to have Buehler again in working type, and definitely among the younger arms they’ve proven off as properly, however they’ll want some veterans to stabilize the unit and on the very least eat innings. That Kershaw will finish this season 40 or 50 strikeouts in need of 3,000 might assist incentivize his return to the fold, as he’d look very bizarre celebrating that career-capping milestone as a Texas Ranger (and haven’t the Rangers spent sufficient on pitching these days?).
All of these are issues for an additional day. As for the subject of UCL reconstruction, based on Jon Roegele’s Tommy John Surgical procedure Database, Gonsolin would be the twenty second main league pitcher to endure the process this 12 months, a rely that doesn’t embrace Ohtani or Bautista, whose programs of motion have but to be decided. Right here’s how the numbers examine over the previous decade and a half:
A caveat right here: Whereas the drop-off in skilled pitchers present process the surgical procedure this 12 months seems encouraging, I wouldn’t take the present rely as gospel; minor league accidents are typically underreported usually, and sometimes with delays concerned. After I look again at previous variations of this train, it’s clear among the annual numbers have grown. The key league totals I’d regard as complete, nonetheless — it’s powerful to overlook these.
Anyway, on the main league degree, this 12 months’s complete of twenty-two TJs together with Gonsolin is down from final 12 months’s 26, although in fact we might nonetheless see extra earlier than the tip of the 12 months. We’re nonetheless properly beneath the single-season excessive of 35, set in 2012, and the spike to 31 in ’21, which doubtless owed one thing to pitchers ramping up after the pandemic-shortened season. The downward pattern since 2021 is offset by the fact that the four-year common of 27 is the very best it’s been since 2012–15 (additionally 27), and it’s nearly definitely destined to go increased; final 12 months there have been 5 TJs after September 1, whereas in 2021 there have been 4.
Having stated that, I don’t see something but to counsel that the brand new pitch clock rule is resulting in any form of spike in TJs (there have been a handful of articles in Could and June exploring the query). It’s notable that the severity of pitcher accidents — as in, longer stays on the IL, even after accounting for the rise within the minimal stint from 10 days to fifteen — has risen over the previous couple of seasons based on Baseball Prospectus’ Derek Rhoads and Rob Mains. “In comparison with 2021, the rise in common IL stint for pitchers this 12 months from the beginning of the season this 12 months is 5.4 video games by way of July 31 and 5.3 video games by way of the 124th day.” (The 124th day this 12 months was July 31, however the authors are simply protecting their bases to account for final 12 months’s lockout). Moreover, Rhoads and Mains introduced a graph displaying that the share of pitcher ILs keep lasting 25 days or longer crossed the 50% threshold final 12 months and that eyeballs someplace within the mid-50s now. Nonetheless, it’s value remembering that, as longtime large league athletic coach turned analyst Stan Conte instructed MLB.com’s Anthony Castrovince, “[The injured list] is a roster administration device, not an harm database.” With TJs, we now have some accounting to fall again upon.
The Dodgers aren’t the one crew to lose two of their high starters to TJ this 12 months. The Rays misplaced Jeffrey Springs in Could, earlier than dropping McClanahan, and I’m not even counting Drew Rasmussen, who underwent the UCL inside brace process — which takes much less time to return from however is way much less frequent — in July. The Rockies misplaced each Germán Márquez and Antonio Senzatela, whereas three different groups have misplaced two main league pitchers to TJ this 12 months, specifically the Angels (José Quijada and Austin Warren), Reds (Connor Overton and Reiver Sanmartin), and Twins (José De León and Tyler Mahle). Fifteen groups haven’t misplaced anybody on the main league degree this 12 months, fortunately.
With Ohtani’s destiny within the steadiness, with Could and McClanahan each having undergone their second TJs, and with Buehler working his approach again from his second, I did some analysis into their frequency as properly. On the main league degree, two different pitchers have gone again for seconds this 12 months, specifically Trevor Rosenthal, who hasn’t pitched within the majors since 2020 because of different accidents, and Jacob deGrom, who was simply six begins into his $185-million contract when his elbow lastly gave approach.
As you may surmise from the pandemic-era wave of TJs, we’re seeing an growing variety of revisions on the main league degree, although we’re nonetheless speaking fairly small numbers. Right here’s the identical interval from the graph above, damaged into first-timers and second-timers (or, within the circumstances of Jason Isringhausen and Jonny Venters, third-timers):
Again in 2014, an enormous group of 11 pitchers underwent a second (or within the case of Venters, third) TJ, and by and huge, the outcomes have been bleak. 4 of them (Pedro Figueroa, Jeremy Hefner, Jarrod Parker, and Josh Johnson) by no means pitched one other large league recreation, and three others barely made a dent: Brandon Beachy solely made two extra appearances however was nonetheless attempting to come back again as late as 2019, whereas Sean Burnett and Cory Luebke every made 10 or fewer extra main league appearances. Venters, Tyler Chatwood, Kris Medlen, and Peter Moylan have been the success tales in that they every returned to pitch in a number of seasons, however their post-second TJ careers have been restricted in impression.
Return charges have improved since then, in that 13 of the 18 pitchers to endure a second TJ within the 2015-20 span made it again to the majors, with Mike Clevinger (2020), Nathan Eovaldi (2016), and Jameson Taillon (2019) all sticking in rotations for a number of seasons. Eovaldi and Taillon each pitched properly sufficient to internet profitable free agent offers, and Eovaldi has since made two All-Star groups. One other pitcher from that span, Caleb Ferguson, has emerged as a mainstay within the Dodgers’ bullpen.
One factor that separates that 2015-20 group from the Class of 2014 is longer timespans between surgical procedures. The 11 pitchers from 2014 averaged solely 4.5 years between surgical procedures, with Beachy, Hefner, Luebke, and Venters every needing a follow-up inside two years; solely Burnett and Chatwood went greater than seven years between. From the 2015-20 group, the common is as much as 5.9 years, with solely two pitchers needing a revision inside two years (Tim Collins and Joel Hanrahan). Of the 4 from that group who went greater than seven years between surgical procedures, two of them have been Clevinger (8.3 years) and Eovaldi (9.2 years), however of the opposite two, Edinson Volquez (8.0 years) and Sam Freeman (10.2 years), the previous made simply 18 extra appearances with ERAs above 6.00, whereas the latter by no means returned to the majors.
At this writing, I’ve not achieved the complete math on earlier than/after efficiency comparisons, or in contrast the surgery-to-return intervals of the successes to the remaining, however someday after 2014, groups realized that returns from second surgical procedures wanted extra time than the everyday 13-15 months for first surgical procedures. To cherrypick just a few knowledge factors, Clevinger (18 months to return to the majors), Eovaldi (21), Ferguson (20) and Taillon (20) mirror this adjustment in considering, however then so did Volquez (20). Through a 2020 paper within the Orthopaedic Journal of Sports activities Medication that synthesized the outcomes of 29 earlier research that met their methodological requirements, we do have some systematic accounting to go by:
After main UCLR [ulnar collateral ligament reconstruction], Main League Baseball (MLB) pitchers returned to play in 80% to 97% of circumstances in roughly 12 months; nonetheless, return to the identical degree of play (RTSP) was much less frequent and took longer, with 67% to 87% of MLB pitchers returning in about 15 months. RTP charges for MLB pitchers after revision UCLR have been barely decrease, starting from 77% to 85%, whereas RTSP charges ranged from 55% to 78%… All research discovered a lower in pitching workloads after UCLR. Fastball utilization can also lower after UCLR. Modifications in earned run common and walks plus hits per inning pitched have been inconclusive.
Based mostly on Roegele’s knowledge, no pitcher has returned from even a primary Tommy John surgical procedure in lower than 13 months for the reason that Cardinals’ Dakota Hudson, who did so in 362 days (from September 28, 2020 to September 4, 2021), which is why what Buehler and the Dodgers are doing on the subject of his second surgical procedure (which happened final August 22) feels extremely dangerous. Hyun Jin Ryu returned from his second surgical procedure in 13 1/2 months, however he additionally went a document 18 years between surgical procedures, and cashed in by way of an $80 million free agent contract signed in December 2019. Buehler is making $8.025 million in his penultimate 12 months of membership management, and thus placing a really massive multiyear payday on the road by speeding again. For his sake, I’d quite see the Dodgers throw the brakes on his return, significantly given what we learn about the impression of excessive velocities on UCLs.
As for more moderen revision recipients, Ryu is one in every of simply three pitchers (out of 14) who has undergone a second TJ for the reason that begin of 2021, and he has all of 5 begins beneath his belt, although he’s pitched fairly properly. Of the opposite two, Kirby Yates, who had his revision achieved in March 2021, is having a strong season within the Braves’ bullpen, whereas John Curtiss, who had his in September ’21, made simply 15 main league appearances for the Mets earlier than not too long ago present process surgical procedure to take away free our bodies from his already-scarred elbow.
Of the remaining, there are just a few hopeful tales. Chris Paddack, who had his second surgical procedure on Could 18, 2022, has a rehab project lined as much as begin on September 6, with hopes of returning later within the month. The Reds’ Tejay Antone — the identify is a bit on the nostril on this context — had his revision on August 27, 2021; he battled extra elbow troubles earlier within the season however has made 14 minor league rehab appearances, the latest one on Wednesday with Triple-A Louisville. Hopefully he might return in September as properly. Joe Ross, who had his revision in June 2022, has made three minor league appearances for the Giants previously 10 days, whereas Brandon Bailey, who had his second TJ in February ’21, has two minor league appearances within the White Sox group this month in his first recreation motion since ’20. John Axford, who went almost 18 full years between his first and second surgical procedures, pitched for Staff Canada within the World Baseball Traditional, however whereas the 40-year-old righty has not formally retired, he’s unsigned.
If Ohtani performs out the remainder of the season earlier than present process his second TJ (assuming his tear is extreme sufficient to advantage it, which is an unknown) in October, presumably he received’t pitch in any respect till 2025. That may give him not less than 18 months between surgical procedure and return, and given the {dollars} — and velocity — at stake, it wouldn’t be a shock if he waited longer.
Due to the stresses that repeated high-intensity throwing locations on arms, Tommy John surgical procedures are an inevitability inside baseball. Inside the knowledge, we’ve not less than begun to see indicators of groups studying to not rush TJ recipients again to the majors. That’s small progress, however it’s one thing to hold onto, not less than.