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.

MLB Tommy John Surgeries, By Year
Year MLB TJ Surgeries
2016 12
2015 20
2014 24
2013 15
2012 26
2011 8
2010 6
2009 17
2008 8
2007 12
Surgeries before July 12 of each year

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.

Known MiLB Tommy John Surgeries, By Year
Year Known MiLB TJ Surgeries
2016 38
2015 60
2014 63
2013 44
2012 39
Surgeries before July 12 of each year

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.

Return to MLB After TJ Surgery for Starting Pitchers
Year of TJ 13 months or less 14 months or more
2015 0 2
2014 0 10
2013 1 5
2012 7 9
2011 4 3
2010 2 2
2009 4 3

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.

2016 MLB Pitchers Who Have Had TJ Surgery, By Team & Usage
Team Pitchers Used Pitchers Pitchers Not Used, on DL DL Pitchers
Athletics 10 John Axford 2 Jarrod Parker
Andrew Triggs Felix Doubront
Jesse Hahn
Daniel Coulombe
Rich Hill
Ryan Madson
Eric Surkamp
Fernando Rodriguez
Dillon Overton
Chris Bassitt
Reds 10 Steve Delabar 1 Homer Bailey
Jumbo Diaz
Josh Smith
Dayan Diaz
Alfredo Simon
Layne Somsen
AJ Morris
John Lamb
Blake Wood
Timothy Melville
Tigers 10 Anibal Sanchez 0
Dustin Molleken
Logan Kensing
Alex Wilson
Shane Greene
Drew VerHagen
Jordan Zimmermann
Mike Pelfrey
Bruce Rondon
Bobby Parnell
Indians 9 Jeff Manship 0
Cody Allen
Dan Otero
Joseph Colon
Danny Salazar
Joba Chamberlain
Carlos Carrasco
Michael Clevinger
Josh Tomlin
Marlins 9 Chris Narveson 1 Carter Capps
Jo-Jo Reyes
Fernando Rodney
Dustin McGowan
Wei-Yin Chen
Bryan Morris
Brian Ellington
A.J. Ramos
Jose Fernandez
Royals 8 Edinson Volquez 2 Jason Vargas
Joakim Soria Tim Collins
Danny Duffy
Alec Mills
Brooks Pounders
Luke Hochevar
Kris Medlen
Peter Moylan
Blue Jays 7 Jason Grilli 0
Joseph Biagini
Arnold Leon
Dustin Antolin
Drew Hutchison
Gavin Floyd
Roberto Osuna
Braves 7 Jason Grilli 4 Shae Simmons
Matt Marksberry Paco Rodriguez
Arodys Vizcaino Jesse Biddle
Casey Kelly Andrew McKirahan
Eric O’Flaherty
Chris Withrow
Daniel Winkler
Pirates 7 Ryan Vogelsong 0
Mark Melancon
Francisco Liriano
Arquimedes Caminero
Neftali Feliz
Cory Luebke
Jameson Taillon
Rangers 7 Colby Lewis 0
Shawn Tolleson
Matt Bush
Sam Dyson
A.J. Griffin
Martin Perez
Yu Darvish
Rockies 7 Jake McGee 1 Jairo Diaz
Scott Oberg
Jorge de la Rosa
Justin Miller
Jason Motte
Tyler Chatwood
Adam Ottavino
Diamondbacks 6 Keith Hessler 0
Andrew Chafin
Rubby de la Rosa
Kyle Drabek
Daniel Hudson
Patrick Corbin
Dodgers 6 Chin-hui Tsao 1 Brett Anderson
Hyun-Jin Ryu
Adam Liberatore
Alex Wood
Ross Stripling
Brandon McCarthy
Giants 6 Albert Suarez 0
George Kontos
Josh Osich
Hunter Strickland
Cory Gearrin
Derek Law
White Sox 6 Miguel Gonzalez 0
Michael Ynoa
Scott Carroll
Matt Purke
Nate Jones
Daniel Webb
Yankees 6 Kirby Yates 0
Nathan Eovaldi
Conor Mullee
Nicholas Goody
Ivan Nova
Branden Pinder
Padres 5 Matt Thornton 0
Fernando Rodney
Keith Hessler
Leonel Campos
Robbie Erlin
Phillies 5 Andrew Bailey 0
Elvis Araujo
Vincent Velasquez
Charlie Morton
David Hernandez
Angels 4 Al Alburquerque 1 C.J. Wilson
Javy Guerra
Cam Bedrosian
Andrew Heaney
Astros 4 Scott Feldman 0
Tony Sipp
Pat Neshek
Will Harris
Mets 4 Erik Goeddel 1 Zack Wheeler
Jacob deGrom
Steven Matz
Matt Harvey
Nationals 4 Shawn Kelley 1 Aaron Barrett
Stephen Strasburg
Sammy Solis
Lucas Giolito
Brewers 3 Wily Peralta 0
Chris Capuano
Sam Freeman
Cardinals 3 Seung Oh 1 Lance Lynn
Jaime Garcia
Adam Wainwright
Cubs 2 Hector Rondon 2 Dallas Beeler
John Lackey Joe Nathan
Orioles 2 Brian Duensing 0
Dylan Bundy
Rays 2 Tyler Sturdevant 2 Alex Cobb
Matt Moore Chase Whitley
Red Sox 2 Junichi Tazawa 1 Brandon Workman
Carson Smith
Twins 2 Kyle Gibson 0
J.T. Chargois
Mariners 1 Adrian Sampson 1 Charlie Furbush
Total 161 22
Percentage 26.20% 59.50%
Overall 28.00%

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.

2016 MLB Draftees Who Have Had Tommy John Surgery
Player Year of TJ Draft Team Draft Position
Cal Quantrill 2015 Padres 8
Jordan Sheffield 2013 Dodgers 36
Mitchell White 2013 Dodgers 65
Braden Webb 2014 Brewers 82
Mason Thompson 2015 Padres 85
Jesus Luzardo 2016 Nationals 94
Scott Moss 2014 Reds 108
Matt Krook 2014 Giants 125
Cole Irvin 2014 Phillies 137
Mikey York 2014 Rays 150
Reid Humphreys 2012 Rockies 200
Sam Tewes 2016 Cardinals 256
Hever Bueno 2016 Rangers 279
Zach Remillard 2014 White Sox 296
Tyler Benninghoff 2016 Twins 333
Chad Donato* 2016 Astros 337
Zach Plesac 2016 Indians 362
Robby Sexton 2015 Red Sox 418
Jesse Stallings 2013 Reds 438
Zach Becherer 2016 Braves 439
Ryan Williamson 2016 Nationals 454
Mitchell Traver 2012 Reds 498
Jacob Bosiokovic 2014 Rockies 560
Kyle Hart 2014 Red Sox 568
Brigham Hill 2012 Athletics 592
Wil Crowe 2015 Indians 632
James Carter 2015 Dodgers 641
Cameron Roegner 2012 Brewers 651
Dante Biasi 2016 Cubs 674
Bailey Ober 2015 Dodgers 701
Heath Holder 2014 Rockies 740
Malcolm Van Buren* 2016 Royals 943
Conor Costello 2013 Dodgers 971
Keegan Thompson 2015 Tigers 985
Jaxon Shirley 2015 White Sox 1016
Morgan Cooper 2014 Nationals 1024
Welby Malczewski 2014 Diamondbacks 1109
Enrique Zamora 2013 Dodgers 1121
Robert Calvano 2014 Cardinals 1156
Kyle Serrano 2016 Brewers 1191
* Tommy John surgery pending

Tommy John surgery data from the Tommy John Surgery List

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Jon Roegele is a baseball analyst and writer for The Hardball Times. He was nominated for a SABR Analytics Conference Research Award in 2014 and 2015. Follow him on Twitter @MLBPlayerAnalys.

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BMac
Member
BMac

Hyun Jin Ryu has never had TJS. He had shoulder surgery for a torn labrum. I hope we can trust the rest of the list.

ChippersJonesing
Member
ChippersJonesing

From Wikipedia:
“In 2004, Ryu underwent Tommy John surgery and did not pitch in any official games. In 2005, he led his team to the Blue Dragon Open National High School Championship, pitching 22 consecutive scoreless innings as the team’s ace and batting .389 in the tournament. He was named Best Pitcher.”