Jonny Venters and the Official Tommy John Threepeat Club

On the same night that top prospect Ronald Acuña made his made his major-league debut, a former Brave had his own memorable moment. In Wednesday night’s Rays-Orioles game at Camden Yards, in the bottom of the sixth inning, 33-year-old Rays lefty Jonny Venters made his first major-league appearance since October 5, 2012. He faced just one hitter, Chris Davis, and needed just four pitches to retire him on a routine grounder to shortstop, but in doing so he became the rare pitcher to return to the majors after a third Tommy John surgery.

Exactly how rare is in dispute, which I’ll examine in greater depth below, but first, let’s appreciate the man and his moment. A 30th-round draft-and-follow pick in 2003 out of a Florida high school, Venters was such an obscure prospect that his name was misspelled “Benters” on some draft lists according to John Sickels. He began his professional career in 2004, but by the end of 2005, when he was 20, he had already gone under the knife of Dr. James Andrews for his first Tommy John surgery. That cost him all of the 2006 season. Working primarily as a starter, he reached Double-A in late 2008 and Triple-A in 2009. Though he didn’t make the Braves the following spring, he was soon called up and debuted against the Rockies on April 17, 2010 with three shutout innings.

Able to Bring It with rare velocity for a southpaw (95.1 mph average according to Pitch Info), Venters proved effective against righties as well as lefties and quickly gained the trust of manager Bobby Cox; by June, he was working in high-leverage duty. In 79 appearances as a rookie, he threw 83 innings and struck out 93, finishing with an ERA of 1.93, a FIP of 2.69, and 1.5 WAR. The next year, he made an NL-high 85 appearances and turned in similarly strong numbers in 88 innings, making the All-Star team along the way. The heavy usage was a bit much for his elbow to take, however. By mid-2012, a season during which he made a comparatively meager 66 appearances, he was briefly sidelined by elbow impingement. He began the 2013 season on the disabled list due to lingering elbow pain and soon received a platelet-rich plasma injection to promote healing. On May 16, he underwent his second TJ surgery, also by Dr. Andrews. To that point, he owned a 2.23 ERA, 3.00 FIP, and 26.6% K rate in 229.2 major-league innings.

Little did Venters know it would take more than half a decade to complete that 230th inning. Before he could return to game action, he suffered a flexor strain, for which he received another PRP injection in May 2014, and in August, it was discovered that he’d again torn his UCL. His third surgery was done by Dr. Neal ElAttrache on September 17, 2014. In November of that year, the Braves released him.

The Rays signed Venters to a two-year minor-league deal in March 2015, allowing them to oversee his rehab. He made five appearances for their High-A Charlotte affiliate in June 2016, throwing as hard as 94 mph, but further elbow pain shut him down. He actually needed another elbow procedure, “a half Tommy John surgery” in which Dr. ElAttrache re-sutured the tendon layer of Venters’ scarred elbow to the ligament layer. Re-signed to yet another minor-league deal by the Rays, he threw 23.2 innings across four minor-league levels from June 27 to September 2 of last year, whiffing 29 while allowing just six runs. His last appearance was at Triple-A Durham, where — after eight spring-training appearances for the Rays without allowing a run — he began this season. He made five appearances, walking five but striking out six, before getting The Call.

Here’s the clip of Venters coming into Wednesday night’s game and facing Davis:

Pretty damn cool — and historic, too. Various outlets reported that both Jose Rijo and Jason Isringhausen had returned to major-league action after a third Tommy John surgery, but as of last week, Jon Roegele, keeper of the Tommy John Surgery database and owner of as much knowledge about the procedure’s history as anyone without a scalpel, regarded Venters as the first pitcher to return from a third TJ due to a lack of confirmation regarding the nature of the other two pitchers’ many elbow-related procedures. “I don’t know what to believe,” he told FanGraphs as to the conflicting accounts regarding Venters’ predecessors, “so I’ve always had the one Isringhausen and four Rijo surgeries on my ‘unconfirmed’ surgery tab.”

The Dominican-born Rijo, who debuted in the majors as an 18-year-old Yankee in 1984 and was traded to the A’s in a deal for Rickey Henderson that December, enjoyed a fair amount of success over his first dozen years in the majors, winning 111 games, leading the NL in strikeouts in 1993, making an All-Star team in -94, and finishing in the top five in the NL Cy Young voting twice. Most notably, he was the MVP of the 1990 World Series, in which the Reds defeated the A’s, going 2-0 with an 0.59 ERA against a club that featured not only Henderson but also Dave Parker, for whom Rijo had been traded in 1987.

Rijo pitched through elbow pain in 1995, discomfort that was initially attributed to a bone spur that had been discovered when he was 17 years old. He received a cortisone shot and rested, but further pain prompted an MRI that revealed a partially torn UCL. On August 22, Dr. Andrews performed Rijo’s lone documented TJ surgery. He was 30 years old at the time. With rehab protocols still in the dark ages, he was throwing 90 mph in spring training the following year, but his velocity soon declined, and… long story short, he didn’t pitch a competitive game for the rest of the millennium. In 1996 and -97, he underwent three surgeries, one to remove elbow calcification and two to repair a ruptured flexor tendon.

It’s those last two surgeries that Roegele believes were miscounted as TJs, referring me to passages in the book Baseball Injuries: Case Studies, by Type, in the Major Leagues, by W. Laurence Coker, M.D. Rijo sat out the 1998-2000 seasons, but mounted a comeback in 2001 at the age of 36. He returned to the Reds in time to throw 17 innings of relief that year, and made 31 appearances totaling 77 innings in 2002. At the time, it was reported that he’d had three TJs.

From an April 28, 2002 story by John Erardi in the Cincinnati Enquirer, the week after Rijo had recorded his first major-league win in seven years:

“You know that movie, The Rookie?’ asked Rijo. “I haven’t seen it yet, but I’m pretty sure it’s not even close to what has happened to me. To be out of the game is one thing. But to have three Tommy John surgeries, and two more arm surgeries, and now to be pitching again seven years later? Nobody would make a movie out of that, because nobody would believe it.”

The last time, the third Tommy John surgery, there was virtually no ligament left to attach to the two bones to keep Jose Rijo’s throwing arm together.

So Dr. James Andrews winged it.

“He had to find a strand of ligament, a strand of tendon, anything he could find in there that would stay together and heal,” Reds medical director Tim Kremchek said.

As I noted at the time of Rijo’s appearance on the 2008 Hall of Fame ballot, Dr. Kremchek wasn’t entirely joking when he described Rijo’s wounded wing: “[H]e has enough arthritis in his elbow, scar tissue, changes, bone spurs that have stabilized his elbow, plus his knowledge of pitching, to make him effective.” Alas, following surgery to remove a bone chip in March 2003, Rijo never pitched again.

As for Isringhausen, the former member of the Mets’ “Generation K” trio of mid-1990s pitching prospects, he debuted in 1995 and underwent his first TJ on January 13, 1998, by which point he’d already undergone surgeries to remove a bone chip from his elbow and repair a torn labrum. Upon returning in 1999, he soon shifted to the bullpen and began a successful career as a closer for the A’s and Cardinals, making two All-Star teams and leading the NL in saves once. Six times in the span from 2000 to -06, his teams made the playoffs, but Isringhausen missed the Cardinals’ 2006 championship run due to an arthritic hip that required surgery in late September.

After a strong 2007, Isringhausen battled injuries in 2008, and underwent surgery on September 12 of that year. At the time and afterwards, it was reported that he was having surgery to repair a torn tendon, though the Baseball Prospectus injury database describes the procedure as “Flexor Tendon and Possible Tommy John Surgery.” Because Isringhausen was back on on a minor-league mound as of April 20, 2009, and in the majors by May 9 of that year — just under eight months later — Roegele was skeptical that it was a true TJ.

With an assist from Roegele, Isringhausen spoke to FanGraphs and set the record straight, confirming that the 2008 surgery was not TJ, and that the surgery he underwent on June 16, 2009, after just nine appearances with the Rays, was in fact his second such procedure. While rehabbing, he realized that the ligament felt “too loose” for him to throw, and he underwent a third surgery — previously unrecorded in Roegele’s database — in September 2009. Because Isringhausen’s previous two surgeries had used tendons from each wrist for the grafts, Dr. George Paletta, who performed all three of his TJs, used a cadaver tendon. “A young man that was unfortunate to lose his life gave me a piece of his body,” Isringhausen said in 2012. “I don’t know anybody else who is trying to do this after three Tommy Johns.”

Isringhausen recovered from his third surgery and made seven appearances with the Reds’ Triple-A Louisville affiliate in July and August 2010, “a little quick” given the standard rehab protocol. He applied lidocaine patches to his arm to ease the discomfort. After that stint, he figured he would retire, but when he realized while playing softball that winter that his arm “had some zip left in it,” the 38-year-old righty called Mets assistant general manager J.P. Ricciardi, and ended up signing a minor-league deal with an invitation to spring training. He made 53 appearances that year and secured his 300th career save, then made another 50 appearances for the Angels before calling it a career, having undergone 11 surgeries.

At least one other pitcher, Josh Johnson, has reportedly undergone three TJ surgeries, but he never returned to the majors after the second, done in April 2014, and never pitched after the third (late 2015) despite signing a minor-league deal with the Giants in November 2015. Roegele’s database notes that pitchers such as Chad Fox and Scott Williamson, who were once believed to have undergone a third procedure, instead had other surgeries.

As a confirmed survivor of “the threepeat,” Isringhausen has a unique appreciation for Venters’ journey back. “For Johnny to never give up his dream and have the perseverance to get through the multiple years of rehab to get back to the major leagues is an unbelievable feat and something he should be very proud of,” he told FanGraphs. “I’m sure it was very emotional that first night on the mound. I’m very happy for him.”

For Venters, as well as Isringhausen, it seems likely that their attempts to accelerate the rehab protocol and return too quickly from surgery contributed to the subsequent failures of their repaired ligaments. In recent years, as the number of so-called revision surgeries has risen, pitchers and teams have learned that more time is necessary for the second (or third) recovery than the first. According to Roegele’s data, recent repeaters such as Brandon Beachy, Tyler Chatwood, Daniel Hudson, and Kris Medlen have taken 15 to 20 months to return to the same level.

At 59 months to return from his last surgery, Venters owns the third-longest timespan behind Rijo (72 months) and Ryan Feierabend (64 months). But regardless of his standing there, or whether he’s the first, second, or third pitcher to return from three TJs, his is a tale of remarkable persistence. Here’s hoping that UCL — and his comeback — stays intact.