Sandy Alcantara’s Volume and Velocity Lead to an All-Too-Familiar Place: Surgery

Alas, even throwbacks get injured. For all of the excitement about the extent to which Sandy Alcantara bucked recent trends by piling up innings and pitching complete games en route to the 2022 NL Cy Young award, his combination of volume and velocity — both at the outer edge of what pitchers of recent vintage have shown they could sustain — placed him at risk for an arm injury. His season ended about a month before those of his Marlins teammates, who made it as far as the NL Wild Card Series, and on Friday the 28-year-old righty announced that he had undergone Tommy John surgery, which will sideline him for the 2024 season.

Alcantara missed just one start over the first five months of the season due to a bout of “very mild” biceps tendinitis in late April, but after throwing eight innings in his September 3 start against the Nationals, he landed on the injured list with what was initially diagnosed as a flexor strain. On September 13, Marlins manager Skip Schumaker told reporters that an MRI revealed that Alcantara had actually sprained his ulnar collateral ligament. Even so, he soon resumed a throwing program. After multiple pain-free bullpen sessions, he was allowed to make a rehab start for Triple-A Jacksonville on September 21. He threw four scoreless innings, but afterwards told the team that he felt renewed tightness in his forearm. The Marlins announced that he was being shut down for the remainder of the season.

While the Marlins hadn’t offered any indication that Alcantara’s sprain was significant enough to merit surgery, it’s not terribly surprising; after all, a sprain is a tear, and with a UCL sprain, it needn’t be a full thickness tear to require surgery. It’s unclear whether the injury worsened with that rehab outing, but the more likely explanation is that as with the Orioles and Félix Bautista, the Marlins qualifying for the postseason made it worth seeing whether Alcantara could pitch through a partial tear. The answer, sadly, was no.

Even before the initial injury, Alcantara’s season had been a significant step back from his Cy Young-winning campaign, during which he pitched to a 2.28 ERA and 2.99 FIP in a major league-high 228.2 innings while striking out 207 hitters. This year, in 184.2 innings — merely the majors’ 20th-highest total — he posted a 4.14 ERA and 4.03 FIP, though his results, if not his underlying peripherals, were much better in the second half than the first; he dropped from a 4.72 to 3.20 in terms of ERA but just 4.07 to 3.89 in terms of FIP. While his average four-seam fastball velocity was unchanged from 2022 (98.0 mph according to Statcast) and that of his sinker only dipped from 97.8 to 97.6, batters hit him a bit harder, and his strikeout, walk, and homer rates eroded substantially:

Our two pitch-modeling systems both saw notable declines in Alcantara’s slider and signature changeup:

Those metrics don’t even account for the results against hitters, but after holding batters to a .146 AVG and .195 SLG against his changeup in 2022, Alcantara was hit for a .282 AVG and .401 SLG against the pitch. His whiff rate via the changeup declined from 34.6% to 29.9%.

In the grand scheme, that Alcantara ended up needing Tommy John surgery is altogether unsurprising, as he’s been one of the game’s hardest throwers at high volume. His average four-seam velocity has led major league starters for three straight seasons, with his average sinker velocity coming within 0.1 mph of doing so — and one can certainly quibble with the 2021 rankings, as Statcast considers Gerrit Cole qualified on the basis of his meeting the total threshold of 1,500 pitches thrown, though just 25 of his were sinkers that year, compared to 873 for Alcantara.

Alcantara has been even further ahead of the pack in terms of workload. His total of 228.2 innings in 2022 is the majors’ highest since ’16, and one of just two seasons of the 2020s that cracks the top 25 of what we might call the Statcast era (2015 onward):

Meanwhile, Alcantara’s three-year total of 619 innings (including 205.2 in 2021) led the majors, 28 ahead of Cole and 39.2 ahead of third-ranked Aaron Nola. His six complete games from 2022 was higher than any team total since ’19, and higher than any individual total since Chris Sale threw six in ’16.

As noted in a variety of ways here over the years, starting pitchers aren’t throwing as many innings as before, a trend owing to numerous factors, including teams’ awareness of the times-through-the-order penalty and ever-rising velocity and strikeout rates. The disruption caused by the pandemic-shortened 2020 season is part of the equation as well, as starter workloads just haven’t been rebuilt to the same degree in subsequent seasons.

Alcantara publicly embraced a workhorse approach, telling CBS Sports’ Matt Snyder last year, “My mentality is to go deep into games and finish my own games. I’m that guy who likes to compete. I’m that guy who likes to challenge the hitter. I’m the guy who will go out and fight.”

The pitcher emphasized last year that he wasn’t throwing at maximum effort all of the time, telling The Athletic’s Andy McCullough, “If you start the game using all your velo, maybe you’re going to get tired in the third inning, maybe in the fifth… But I’m not like that. I like to start the game nice and easy, relax a little bit. After the fifth inning, I’ve got to use all my powers.”

Here it’s worth noting that Alcantara’s efficiency did mitigate his workloads to some extent. In 2022, he reached or exceeded 110 pitches in a start — a rather arbitrary threshold to begin with — just five times, well below the Statcast-era maximum of 18 reached by Sale in 2017 and Trevor Bauer in ’19. Note that the majors-wide total of such outings plummeted from 219 in 2019 to 60 this year. Alcantara didn’t even lead the majors in 110-pitch outings in 2022, as Luis Castillo had six between his stints with the Reds and Mariners. Alcantara did so just three times in 2023, and for the three year period never once threw 110 innings in back-to-back outings. His streak of seven consecutive starts with at least 100 pitches from May 16 to June 19 in 2022 was matched or exceeded nine times from 2021–23, including twice by Corbin Burnes.

Even without pitch counts going into the red, it’s not surprising that Alcantara’s combination of volume and velocity would carry a cost. What’s striking about the increasing rarity of pitchers reaching the 200-inning plateau (just five did it this year, down from eight last year, and 15 in 2019) is that the pitchers who repeat the feat inevitably pay the price. Twenty-four pitchers have thrown 200 innings in a season multiple times since 2015. Five have had Tommy John surgery since doing so, and the attrition rates on the others at least feels high:

None of those retirees made it to their age-40 seasons, or came close to reaching 3,000 innings, once a common career plateau. Lester retired after his age-37 season and 2,740 innings. Price (age-36 season, 2,143.2 innings), Hamels (age-36 season, 2,698 innings), Shields (age-36 season, 2,616 innings), Samardzija (age-35 season, 1,645.1 innings), and Porcello (age-31 season 2,096.1) didn’t even last that long. The book may be closed on Archer (age-33 season, 1,357 season) as well, as he didn’t pitch this past season. Corbin, Keuchel, and Kluber probably aren’t long for the majors judging by this year’s performances, and I haven’t seen a single report of anybody calling to inquire about Bumgarner once the Diamondbacks released him in late April with about $34 million still remaining on his contract. Meanwhile, Bieber, Mikolas, and Nola didn’t have anything close to their best seasons in 2023.

Aside from the future Hall of Famers (Greinke, Scherzer, and Verlander), Cole is the rare pitcher here who has not only survived but thrived, perennially throwing 200 innings while drawing Cy Young consideration, though we’ll see how he holds up down the road. Cole aside, I don’t think that set of outcomes bodes well for repeated trips to the 200-inning line, at least not unless conditions change to make pitching less stressful — which would probably involve deadening the ball to take away offense, and/or further limiting pitching staff sizes to put a premium on eating innings via shorter plate appearances.

Anyway, since I last checked in on Tommy John surgery trends in late August, the list of major league pitchers receiving the surgery has expanded to include both Alcantara and Bautisa, with Shohei Ohtani apparently receiving the internal brace procedure — which involves the creation of an artificial ligament using collagen-coated suture tape, can only be used on certain types of tears, and has a shorter recovery time than traditional Tommy John. That brings this season’s total to 24 major league pitchers, two shy of last year and down from 30 in 2021.

If there’s good news for Alcantara, it’s that he’s got some security here. Had he not signed a five-year, $56 million extension in November 2021, he would have hit free agency after his year of rehabbing. Instead, he’ll make $9 million next year (up from $6 million this year and $3.5 million last year), and then $17 million apiece in 2025 and ’26 with a $21 million option and $2 million buyout for ’27. That’s less than he would have earned as a healthy pitcher reaching free agency, of course, but that’s the risk/reward tradeoff he made by signing that extension.

As for the Marlins, who are coming off their second playoff appearance in four seasons, they have three starters in their age-25 seasons, all of whom turned in above-average performances in terms of ERA and FIP this year in Jesús Luzardo, Braxton Garrett, and Edward Cabrera, only one of whom is arbitration-eligible (Luzardo). Eury Pérez, who’s just 20 and who made the leap from Double-A in May, will get a full season in the rotation. Trevor Rogers, who was limited to four major league appearances by biceps and latissimus dorsi strains, will hopefully be healthy enough to compete for a spot, but the team will probably need help via free agency to fill the large footprint of Alcantara’s innings.

Hopefully, Alcantara will come out of this on the other side still an exceptional pitcher. Still, it’s worth remembering that for as much as we’d all like to see starters throw more innings like the days of yore — a yearning that becomes especially acute when juxtaposed against postseason starter management (see José Berríos and Ranger Suárez) – the deck is stacked against them, and it will take more than bravado to reverse it.