Tommy John Surgeries: 2016 Update

It’s no secret that, over the last few years, the number of Tommy John surgeries has increased across all levels of baseball. As we emerge from the All-Star break, let’s take a snapshot of the current state of Tommy John surgeries at the professional ranks.

New Tommy John Surgeries
Let’s start with some good news. The number of Tommy John surgeries at the major-league level is down in 2016 compared with the last couple of seasons. Comparing totals at this point in the season over recent years, there have been fewer Tommy John surgeries to date this year than any since 2011.

In the past five seasons, I’ve attempted to track Tommy John surgeries at the minor-league level more closely than in prior years. This information is much more difficult to collect, and certainly there will be many surgeries missing from the list every season. Looking only at surgeries known to have been performed by this time in the year, however, the 2016 campaign looks more like 2012-2013 than the last two years where surgery counts had spiked.

So the most interesting question here is: has something actually changed to cause the number of Tommy John surgeries to drop this year compared with the last two seasons?

I can’t say that I know the answer, but I suspect it’s due to a number of factors.

The first is that there is some degree of random year-to-year fluctuation, and, by mere chance, some years are going to have fewer than others. It’s possible, perhaps even probable, that this is the main effect at play here.

A second reason could be a growing movement by organizations and players to first attempt alternative solutions to UCL damage before succumbing to Tommy John surgery. Platelet Rich Plasma (PRP) injections or stem-cell therapy treatments have been attempted by several pitchers this season with injured elbows. With rehab timelines in the 6- to 12-week area as opposed to 12 to 18 months, if the UCL damage falls in a range where this type of procedure has shown any sign of promising results, it’s understandable why this course of action would be explored first by players. Even if the PRP injection or stem-cell therapy doesn’t heal the UCL well enough to allow a pitcher to return to action and he eventually undergoes Tommy John surgery, the attempt does not significantly impact the potential return time, especially when performed at certain times of year relative to the MLB schedule.

Angels starting pitchers Andrew Heaney and Garrett Richards have each attempted to stave off Tommy John surgery through such a procedure. In early May, at the Kerlan-Jobe Orthopaedic Clinic, Heaney had bone marrow extracted, concentrated, and injected back into his ailing UCL. The hope with this procedure is that the stem cells in the injection can regenerate into tissue that will keep the UCL intact. While an ultrasound six weeks post-injection did show minimal healing, after another three weeks Heaney tested out the elbow and could not detect any improvement. He underwent Tommy John surgery on July 1.

Richards received the type of same stem-cell injection in mid-May. The condition of his UCL, on the other hand, appeared to have visibly improved when examined at the end of June.

From the latter piece by Jeff Fletcher cited above:

“He’s shown more progress toward healing and things look more improved in his situation,” Eppler said. “We still have another four to six weeks of allowing that injection of the stem cell to run its course.”

After suffering a partially torn UCL in Spring Training, Brewers pitcher Sean Nolin had a PRP injection and is currently pursuing a recovery without requiring Tommy John surgery. This comes on the heels of the Brewers attempting the same procedure with pitchers Tyler Thornburg in 2014 and Taylor Williams last season. While doing so was a success for Thornburg, Williams did eventually undergo a UCL reconstruction surgery last August.

Reds young starter Michael Lorenzen received a PRP injection in April after being diagnosed with a mild UCL sprain in Spring Training. Lorenzen had to overcome mononucleosis in addition to his ailing elbow, but has managed to return to MLB action without Tommy John surgery at this point.

Padres righty Jon Edwards is the latest MLB pitcher with UCL damage to receive a PRP injection. It remains to be seen whether the procedure will allow him to avoid Tommy John surgery. The damage to his UCL is described as “wear,” which perhaps suggests a stretch of the ligament as opposed to a tear. One would expect better outcomes from PRP or stem cell therapy on less significant UCL injuries.

A third potential reason for fewer Tommy John surgeries could be that at least some teams have made strides through research toward actually reducing UCL injuries in pitchers. The Dodgers have clearly reduced pitch counts across their minor-league affiliates, and continue to add brainpower to their medical research staff.

As Jeff Passan pointed out in his book, The Arm, pitching injuries are a billion-dollar problem in the baseball world. There is no doubt in my mind that at least in the past couple of years, some teams have allocated resources to attacking this problem. If even a fraction of these efforts bore fruit, this could also be contributing to the decline in surgeries seen in 2016 to date.

MLB Return Times
There has been a noticeable reluctance on the part of organizations to “rush” MLB starting pitchers back to the big leagues any more in the 12-13 month timeframe following Tommy John surgery.

In the years leading up to 2013, roughly half of all MLB starting pitchers who successfully returned to MLB after having Tommy John surgery did so in 13 months or less from the time of their surgery. As of today, Gavin Floyd was the last MLB starting pitcher to return from the surgery in this timeframe, returning to a big league mound two days shy of a year after undergoing a UCL reconstruction in May 2013.

These counts do not even include all of the starting pitchers who have still not returned to MLB after 14 or more months since having Tommy John surgery. The only starting pitcher left from the 2015 class who could return in less than 14 months is Jason Vargas, if he pitches at the MLB level before mid-September this year. The other seven MLB starters who had Tommy John surgery in 2015 — a group that includes Homer Bailey and Alex Cobb — are all guaranteed to require at least 14 months to return to MLB, if they make it back at all. This is why it was surprising to see reports that the Reds were targeting a 12-month return to MLB for Homer Bailey, as teams have shied away from such aggressive schedules lately. Bailey eventually did hit a snag in his rehab, and by not having returned to MLB yet is now in the 14-plus-month range as has become common.

MLB Pitchers
As of the All-Star break, there have been 161 pitchers used in MLB in 2016 who have had Tommy John reconstruction surgery. This represents 26.2% of all pitchers who have thrown a pitch at the major-league level in 2016 (excluding position players who have pitched). In addition, there are 22 pitchers on the MLB disabled list at the moment who have yet to make an appearance this season who have undergone Tommy John surgery in the past. They make up 59.5% of all pitchers currently on the MLB DL who have yet to pitch in 2016.

In total, this means that, as of today, a startling 28% of all pitchers in Major League Baseball have had Tommy John surgery at some point in their careers. Every team has used at least one pitcher this year who has recovered from UCL reconstruction surgery. The table below details each of these pitchers, by team.

MLB Draft
At the 2016 MLB Draft held in early June, at least 40 athletes selected either have had or are about to have Tommy John surgery. The list of players along with the year of their surgery, drafting organization and overall pick number are shown below. The signing information is up to date as best as I can tell, although information about later round picks is not as readily available. A normal background indicates signed, red indicates will not sign, and yellow refers to undecided players or those for whom signing details are currently unknown.

Tommy John surgery data from the Tommy John Surgery List