A Ray of Hope About Tommy John Surgeries

A rough winter and spring got rougher for the Rays this week, as the team learned that Jose De Leon has suffered a torn ulnar collateral ligament and will require Tommy John surgery. Acquired from the Dodgers in January 2017 in exchange for Logan Forsythe, the now 25-year-old righty ranked among the game’s top-40 prospects by multiple outlets heading into both the 2016 and 2017 seasons. Alas, a trio of stints on the disabled list for a variety of arm ailments limited him to just 41 innings last year, 2.2 of them in his lone major-league outing.

De Leon is the second Rays pitching prospect to require Tommy John surgery this spring, 22-year-old righty Brent Honeywell, a consensus top-15 prospect (including 15th on the FanGraphs Top 100 list), having become the first. The loss of those two righties isn’t the only reason that the Rays plan to work with a modified four-man rotation. Their teardown, which includes the departure of Alex Cobb via free agency and the trade of Jake Odorizzi to the Twins, has led the team to try something different and cost-efficient with the fifth-starter spot, an experiment that could have larger ramifications around the game.

Because De Leon and Honeywell belong to the same team and because their injuries occurred during the same spring — one in which just two other professional pitchers have had Tommy Johnsurgery thus far — it’s natural to wonder if the Rays have a problem in this area. Historically speaking, it seems, quite the opposite has been true. According to the data in the Tommy John Surgery List kept by Jon Roegele, Rays major- and minor-league pitchers have undergone fewer TJs than any other organization since the start of 2010:

Roegele classifies every pitcher in organized ball who undergoes the surgery by the last level at which he pitched prior to going under the knife (in De Leon’s case, High-A via a rehab assignment). For the purposes of this accounting, I excluded all of the hurlers classified as high school or college because of the discrepancies in surgical timing. Consider the cases of a pair of 2015 first-round picks, Brady Aiken and Walker Buehler. Aiken underwent March 2015 surgery before being (re)drafted by the Indians, while Buehler had surgery in August of that year, after being selected by the Dodgers but before throwing a professional pitch. Neither injury is attributable to their respective teams. I chose to start with 2010 because that’s where Travis Sawchik’s recent illustration of declining league-wide levels of TJ surgeries cut off as well. More on that shortly.

Including De Leon (who hasn’t actually undergone the procedure yet), the Rays’ total of 10 surgeries in that span is the majors’ lowest, less than one-third that of the MLB-leading Mets — who, to be fair, haven’t had a pitcher above A-ball suffer that fate since 2015. Even so, using the start of 2016 as a cutoff, the Mets organization’s six TJs, though all from the low minors, place them third among the 30 teams, behind the Giants’ eight and the Reds’ seven. No other team has more than three, which is where the Rays will sit once De Leon goes under the knife.

Returning to the larger data set, one finds this: of the eight other pitchers in the Rays organization who’ve undergone TJ since the start of 2010, four have never reached the majors, including 2011 first-round pick Taylor Guerrieri and supplemental first-rounder Grayson Garvin. Two others had pitched elsewhere in the majors prior to going down — namely Burch Smith (April 2015 surgery; 10 appearances for the 2013 Padres) and Shawn Tolleson (May 2017 surgery; 215 appearances for the Dodgers and Rangers from 2012-16). The other two homegrown products who became rotation staples were Matt Moore (April 2014) and Cobb (May 2015).

Even without the 2010 cutoff, the Rays’ track record in this area is rather remarkable. As I noted at SI.com at the time of Moore’s surgery, the last Rays major leaguer to undergo the procedure before him, and the only one since the beginning of 2007, was Jason Isringhausen in 2009. Izzy was 36 at the time and particularly battle-scarred, having endured at least six previous arm surgeries, including 1998 and 2008 TJs, while with the Mets and Cardinals, respectively.

The Rays’ low total of TJs is said to owe something to the fact that Dr. James Andrews is their team physician. Andrews, of course, is one of the industry’s leading orthopedic surgeons and, according to Roegele’s data, the all-time leader in TJs performed (193, or 110 more than runner-up Dr. Lewis Yocum and 159 more than the procedure’s creator, Dr. Frank Jobe). Andrews is also the co-founder of the American Sports Medicine Institute, which has worked to dispel common myths about the surgery and offer recommendations for keeping youth, amateur, and professional pitchers healthy.

Until the end of last season, the Rays also employed Josh Kalk, an analyst who in February 2009 wrote for The Hardball Times about using PITCHf/x data in a neural network to identify injuries and very soon afterwards was hired by the team, eventually rising to the rank of director of pitching research and development. The Tampa Bay Times‘ Marc Topkin described Kalk as “an expert in PITCHf/x data and injury prevention studies and modeling” at the time of his departure from the organization. (He landed with the Twins.) From Yahoo Sports’ Jeff Passan we learn that, in 2015, the Rays broke ground by installing Kinatrax, a markerless system of capturing biomechanical data, at Tropicana Field. (The Cubs followed suit in 2016, and at least one other team has done so as well.)

Back to Sawchik’s work. Two months ago, he asked via his article title, “Have we Reached Peak Tommy John?” The whole piece is worth a read, but here’s a simplified presentation of the data he cited, with position players and the aforementioned high-school and college hurlers weeded out:

At the major-league level, 18 pitchers underwent TJ last year, one fewer than in 2016. The high total in this span was 35 in 2012, and it was 30 as recently as 2014. In terms of all professional pitchers, last year’s total of 69 TJs was down 12.7% from 2016 and 36.7% from 2015. We can hope that the industry may be past that two-year spike, though it’s probably too early to tell whether it’s just randomness as opposed to better means of prevention.

Which isn’t to say that there haven’t been advances or successes that could be having an effect, thanks not only to the efforts of Kalk and (presumably) other analysts but also other routes of treatment. For example, where platelet-rich plasma injections once appeared to be a Hail Mary when it came to avoiding Tommy John surgery, recent years have seen Masahiro Tanaka (diagnosed with a UCL tear in mid-2014) and Aaron Nola (mid-2016) flourish at the MLB level without surgery. Seth Maness underwent a modified Tommy John procedure called primary repair surgery that allowed him to return to the majors inside of nine months.

Maybe the industry is turning the corner, but if history is any guide, the next few weeks will feature more stories like those of De Leon’s, as pitchers face the hard facts that they just can’t continue without repair. Just under 30% of the surgeries from the past four seasons took place in March or April, with the figure varying only between 25-30% in that span; last year, it was 19 out of 69. Within the next two months, we’ll have a better idea of the trend’s direction.