Tommy John surgery repairs an injured elbow ligament. It’s most commonly done on college and pro athletes, especially baseball pitchers. But it’s sometimes done on younger people as well.
Tommy John surgery is also called UCL reconstruction. UCL is short for ulnar collateral ligament. During Tommy John surgery, a surgeon replaces the injured UCL with a tendon taken from somewhere else in the patient’s body.
The UCL is located on the inside of the elbow. It connects the bone of the upper arm (humerus) to a bone in the forearm (ulna). Anyone can get a UCL injury from repetitive stress to the elbow or from trauma. But throwers have the highest risk. That’s because throwing motions that twist and bend the elbow put extreme stress on the ligament.
Over time, the UCL can develop tiny or large tears. The ligament stretches and lengthens to the point where it can’t hold the bones tightly enough during throwing activities.
Pitchers are fully aware that at any moment, they can feel that pain in their forearm and/or elbow, and their career will be put on hold for that dreaded, but sometimes welcomed, Tommy John Surgery. As we all know, the surgery is named after former Los Angeles Dodgers pitcher Tommy John. In 1974, he underwent the first surgery of this type and when Dr. Frank Jobe, performed the first UCL reconstruction on Tommy John in 1974, a torn UCL tear was considered to be a game-ending injury for most players.
The surgery has evolved over time, but following Tommy John surgery, the players are typically immobilized in a splint or brace for 6 weeks, followed by months of physical therapy and rehabilitation. In general, players may not be ready to throw or pitch competitively for nine to 12 months after surgery. Oft times, it takes another year to fully come back. In fact, sometimes a pitcher comes back and throws even harder than before the surgery. Also, let’s not forget that pitchers are not the only ones who have Tommy John Surgery. Witness our own Corey Seager.
Complications can occur in anywhere from 5% to 20% of patients, depending on the technique that is used. The most common complication is damage to the ulnar nerve. Other complications can include infection or hematoma. Rarely, a complication will require additional surgery, but it does happen. At that point, a successful return to the mound is highly unlikely.
Johnny Venters is the only player to have it three times and make it back to the major leagues. The left-hander had his first procedure in 2005, in Class A. He made it to the Majors with the Braves in 2010 and was an All-Star in 2011. But he hurt his elbow and needed a second Tommy John in 2013. As he tried to rehab from that surgery, he tore his UCL again, requiring a third surgery. And as he rehabbed from the third Tommy John, he tore his UCL a fourth time.
But the way the ligament was torn allowed Dr. Neal ElAttrache to reattach it using a different procedure. Venters came back again. On April 25, 2018, more than five years after his last MLB game, Venters made it back to the mound with the Rays. In July, they traded him back to Atlanta, where he helped his original team win the NL East.
Many players have had Tommy John Surgery and have come back to pitch at a high level. He is a partial list:
- Tommy John
- Jacob deGrom
- Adam Wainwright
- Rich Hill
- John Smoltz
- Eric Gagne
- David Wells
- Billy Wagner
- Brian Wilson
- Joakim Soria
- Francisco Liriano
- Tim Hudson
- Ryan Dempster
- AJ Burnett
- Chris Carpenter
- Jamie Moyer
- Stephen Strasburg
It is becoming more common for a pitcher to come back to his previous level of skill after Timmy John, but that is not a given. It is still a risk. Andrew Friedman is certainly not risk-averse… and that brings me to the point of this whole piece. Andrew has recently signed, drafted, or traded for several pitchers with a history of Tommy John surgery. Tommy Kahnle will likely miss all of 2021 with Tommy John and Corey Knebel is in his second back from the surgery. While Kahnle is a high-leverage reliever, he will likely not be ready until 2022, but Knebel should be back to his nasty old self next season.
Additionally, Freidman has added Jimmy Nelson, Brandon Morrow, Brock Stewart, James Pazos, and Carlos Asuaje to the team in various deals (mostly of the minor league variety). These deals are not to be confused with the signings of starting pitchers in the past, such as Scott Kazmir, Brandon McCarthy, or Brett Anderson. Those were all “stopgap” starting pitchers needed for a time until the Dodgers Farm System could begin to bloom again.
These pitchers are likely all relievers and other than Knebel, none are being counted upon. Even Knebel may not pan out. But, there is a good possibility is that of those six pitchers I just listed, one or two could play big roles for the Dodgers bullpen. The question is “Which Ones?” Now, it’s easy to just write all of them off, but at various times in each of their careers, all have shown at least flashes, of dominance. To me, it’s fun to watch this stuff play out.
Corey Knebel, Brandon Morrow, and Jimmy Nelson have all shown that they have dominant stuff. Nelson may have to re-invent himself as a reliever because the shoulder surgery he underwent what could be described as almost “complete shoulder reconstruction” by Dr. Neal ElAttrache, repairing his rotator cuff, anterior labrum, and capsule. Then, he underwent lumbar surgery in July that forced him to miss the entire 2020 season. This falls into the category of “you never know unless you try.”
You can expect to see more of this by Andrew Friedman. One key component is that these pitchers know the Dodgers medical and physical therapy staff is one of the best in baseball, the facilities are top-notch and they want to be Dodgers. They know that if they can make the team, they will likely play for a Championship. That’s huge! They also know that Andrew Friedman will see that they have a fair shot. That is also huge.
Then we can look forward to 2022 for Tommy Kahnle, who will earn $750K in 2021, and $3.45MM in 2022. He can also earn another $750K worth of incentives. HIs 100 MPH stuff is sometimes filthy. Again, this is a low risk-high reward move that Andrew Friedman loves to make.
By the way, if a player has a disease or surgery named after him, he should be in the Hall-of-Fame. Witness amyotrophic lateral sclerosis or ALS, which is a progressive neurodegenerative disease that affects nerve cells in the brain and the spinal cord. It is now commonly called Lou Gehrig’s Disease, so Tommy John should also be in the Hall of Fame, and his 288 wins also don’t hurt.
The Hot Stove is not so hot!
Discussion (78)
Disagree, not disagreeable
Merry Christmas and Happy New Year to all you LADT and Dodger fans…
When you start your spring cleaning, make sure you leave room on the mantle for some new 2021 W.S. stuff because you know we’re repeating!!!
A little writeup of our minor league system:
https://www.milb.com/milb/news/state-of-the-system-los-angeles-dodgers
2020 Dodgers left field reviewed
· AJ Pollock
Regular Season
Overall (175 PA) — .276/.314/.566, 16 HR, 30 R, 34 RBI, 2 SB, 132 wRC+, 1.0 FanGraphs WAR, 0.9 Baseball Reference WAR
As LF (95 PA) — .275/.295/.560, 8 HR, 16 R, 16 RBI, 1 SB
Fielding, As LF — 1 E, .966 FP, -5 DRS, -19.6 UZR/150
Postseason
Overall — .220/.273/.268, 0 HR, 4 R, 2 RBI, 1 SB
· Joc Pederson
Regular Season
Overall (138 PA) — .190/.285/.397, 7 HR, 21 R, 16 RBI, 1 SB, 55 wRC+, -0.1 fWAR, -0.3 bWAR
As LF (69 PA) — .148/.235/.328, 3 HR, 9 R, 7 RBI, 0 SB
Fielding, As LF — 0 E, 1.000 FP, -2 DRS, 0.7 UZR/150
Postseason
Overall — .382/.432/.559, 2 HR, 4 R, 8 RBI, 0 SB
Chris Taylor
Regular Season
Overall (214 PA) — .270/.366/.476, 8 HR, 30 R, 32 RBI, 3 SB, 131 wRC+, 1.5 fWAR, 2.1 bWAR
As LF (66 PA) — .291/.400/.491, 2 HR, 13 R, 7 RBI, 2 SB
Fielding, As LF — 1 E, .971 FP, 3 DRS, 9.2 UZR/150
Postseason
Overall — .207/.270/.328, 1 HR, 8 R, 3 RBI, 0 SB
Your explanation makes sense, Mark. I guess for that strategy to work, you really have to “buy low” – buy high potential relievers at fire sale prices. Thus, no Brandon McCarthy deals. It will be interesting to see if his strategy pays off.
Merry Christmas LADT followers.
I was busy doing some last-minute shopping today., but I wanted to address couple of things.
#1 David asked: I know that AF knows a lot more than I do, but I don’t quite get why it’s a better strategy to spend money on several injured relievers, than to pay for one proven high-leverage reliever who is not injured. Can anyone enlighten me?
#2 Threalton said: How much money do u spend on a guy like jimmy Nelson who hasn’t pitched in 3 years? I’m estimating that he is already in for about 5 mil on him. Throw another 5 at Kahnle and then morrow will end up at 5 or more probably. Then u got knebel at 5 plus who is certainly no sure thing. Next thing u know u have quite a bit tied up on guys who may or may not pitch. I know spread the risk and short term. So, I know it is a philosophy a strategy. The investment is a lot more than just the salary but I understand if any of these pan out it would be worth it.
Answer: These are very similar issues. Let’s say AF signs Liam Hendriks, for probably 4 years/$48 Million. The odds are his best years were in 2019 and 2020. The odds are very strong he will not repeat that and/or will suffer an injury, like TJ and miss a couple of years. It happens all the time. Relievers are up and down, year-over-year. Very few are the same year-in-and-year out. A few years ago, everyone wanted Craig Kimbrell and Felipe Vazquez. Still want them? Every fan wants last year’s flavor of the year. If you trade for Josh Hader, you may get LH Kenley Jansen. Some of Hader’s peripherals and velo are a little scary.
The Dodgers have $1,250,000 invested in Jimmy Nelson (that is for 2020 and 2021). That’s $625,000 a year
The Dodgers have $4.2 Million invested in Tommy Kahnle over 2 years. That’s $2.1 Million a year.
The Dodgers have minor league deals with Stewart, Pazos and Asuaje at a cost of $1.5 million a year TOTAL (but that does not count toward the Lux Tax)
They have the most invested in Cory Knebel, which will likely be around $4-5 Million THIS year.
If you add it all up, it equals $9.2 Million, but not all of it is on the MLB roster.
There is a very good chance, that one of those pitchers will be as good or better than Hendriks in 2021 and if Joe Kelly can have one good year, then he might be worth it.
I am sure that AF is a student of Statistics and Probability and he knows that his bets are spread out enough that it won’t hurt if they all fail, but if just one delivers, WOW! If more than one delivers, he hit the jackpot!
That’s why he does it.
Merry Christmas to everyone, a big hug from Mexico….
Well at least we know if AF doesn’t sign Seager as our future shortstop there always a place for him in our bullpen! Merry Christmas to everyone!
Merry Christmas to all of you at LADT! I know that AF knows a lot more than I do, but I don’t quite get why it’s a better strategy to spend money on several injured relievers, than to pay for one proven high-leverage reliever who is not injured. Can anyone enlighten me?
What is especially cool about TJ surgery is the number of terrific players who have been able to continue their careers. Mark’s partial list confirms that fact. I think a couple of years ago there were 15 pitchers in the All-Star Game who had undergone TJ surgery. Prior to 74 all these guys would have been washed out. Countless players got hurt, never to be heard from again. I love the old-timers but nobody is correct when they opine that baseball was better “back in the day” before inclusion of players of color, foreign players and players who have had medical procedures keeping them in the game. How much longer might we have enjoyed Koufax if he had today’s medical procedures?
Merry Christmas to all. Please enjoy the holiday and stay safe.
I haven’t been on line for awhile. I just wanted to make sure I wished all you Dodgers fans a very merry Christmas.
Josh Bell traded by the Pirates to the Nationals for two minor league pitchers.
Explain the following statement: While Knebel is a high-leverage reliever, he will likely not be ready until 2022, but Knebel should be back to his nasty old self next season. If he won’t be ready until 2022, how will he be back to his nasty old self next season?
Merry Christmas to all!
Sounds like an awesome Christmas dinner B&P and I’m sure an incredible amount of work.
Yes, Merry Christmas to all! I’ll be spending most of the day in the kitchen preparing for the feast of seven fishes. The trimmed down COVID version. On the menu for tonight.
Course 1
Assorted Cheeses, White and Peppered Anchovies, Seafood Salad with Calamari, Shrimp, Lobster and Scallops.
Course 2
Mussels in a white wine sauce and Bacala in a tomato sauce with Garbanzo Beans.
Course 3
Lazagna, Green Beans with garlic and Olive Oil, Salad
Dessert
Lemon Cloud Pie and assorted Christmas Cookies
Since AF guided the Dodgers to a World Series I am more accepting of areas of disagreement. As a disclaimer I don’t intend to know what he knows which matters. He is planning for long term, short term, financial, etc. while providing the Dodgers with the depth unmatched by any other team. Now after affirming I am always amused by his blue light specials.
How much money do u spend on a guy like jimmy Nelson who hasn’t pitched in 3 years? I’m estimating that he is already in for about 5 mil on him. Throw another 5 at Kahnle and then morrow will end up at 5 or more probably. Then u got knebel at 5 plus who is certainly no sure thing. Next thing u know u have quite a bit tied up on guys who may or may not pitch. I know spread the risk and short term. So, I know it is a philosophy a strategy. The investment is a lot more than just the salary but I understand if any of these pan out it would be worth it.
Another strategy that takes me back to the McCourt days is to overpay for marginal players like pollock and Kelly. How the Dodgers acquired those 2 was giving extra years which nobody else is willing to do. How do I know that? That is what Kelly said. While pollock was good in the 60 game he has been a playoff bust and in his first year mr. injury as predicted. Kelly has just been a bust period. What a waste of talent.
So, the strategy of blue light specials and disabled projects continues. So, how did we overcome? A fantastic farm, player development,using financial might in buying Betts, graterol, treinen, etc while paying to get rid of maeda, puig and others. So, it’s the way the market plays I suppose. I just get irritated when u add up all the money thrown away u could have had a good player or 2 and yet turn around and overspend on mediocrity. It seems contradictory but keep winning the World Series and this fan will be happy.
MERRY CHRISTMAS TO ALL OF YOU. I SINCERELY HOPE EVERYONE HAS A REALLY WONDERFUL DAY. !!!!!
2022 pitching staff could include Kahnle, Caleb Ferguson, Michael Grove (second rd 2018 draft), Braidyn Fink (19th rd 2019 draft), Clayton Beeter (2020 2nd rd supplemental draft), Aaron Ochsenbein (6th rd 2019 draft) along with Walker Buehler — all with TJ surgery in their medical files.
MERRY CHRISTMAS DODGERS FANS!
Oh man, you forgot to mention Hong-Chi Kuo! A survivor of two TJs. He had a couple of really dirty seasons with the club.
It’s Merry Christmas Eve and still little action this offseason outside of the Braves signing one very old and one very mediocre starting pitcher. It seems like no one wants to bend and set the market.
Back to TJ surgery. I would like to see one of the writers do some analysis on how long it has taken some of these pitchers to get back to peak form, rather than how long it takes to get back to a major league roster. As far as Knebel goes, it seems like he’s primed to back this season after trending upward at the end of last year.
I’m not very confident about Nelson or Morrow. Morrow hasn’t pitched in two years and Nelson has thrown just 22 innings in the last three years. Both are lottery tickets and rightfully so. There’s always room for a dominant pitcher in the pen and if it doesn’t work out, it didn’t cost much.
Now, let’s go get a couple of arms that actually look like they’re going to pitch at a dominant level for next year’s pen.
I’ve read that the Indians are also listening on Jose Ramirez. AF needs to go shopping in that multi-family garage sale in Ohio. The Reds and the artist formally known as the Indians have some useful assets.
Who would you rather have at 3B next year, Jose Ramirez or Eugenio Suarez, Kris Bryant or Nolan Arrenado?