Many people use the word “epidemic” when referring to the rate at which baseball players, from the professional ranks down to high school, have been undergoing ulnar collateral ligament (UCL) reconstruction surgeries, more commonly known as Tommy John surgeries.

While torn elbow ligaments have been problematic at all levels of baseball, this article will focus on the latest statistics, trends and information with respect to Tommy John surgeries in major league baseball.

MLB Surgeries

There was promising news regarding the number of Tommy John surgeries performed on major league players in 2016.

TOMMY JOHN SURGERIES ON MLB PLAYERS Year MLB TJ Surgeries 2016 15 2015 27 2014 31 2013 20 2012 36 2011 17 2010 17 2009 20 2008 15 2007 22 2016 surgery total as of Oct. 6

This year saw the lowest number of Tommy John surgeries of any year in the past decade. The one disclaimer is that the year is not over yet, so there may yet be additional surgeries to add to the tally. In particular, Oakland right-hander J.B. Wendelken is to get a second opinion this week on his injured right elbow, and is not optimistic he can avoid a UCL reconstruction.

While some or maybe even most of the reduction in surgeries observed in 2016 could be just random year-to-year fluctuation, there were also more public signs of players trying alternative therapies than in prior seasons.

Garrett Richards is the most prominent example of a different course of action looking so far so good, as after a stem cell injection in mid-May in the area of his partially torn UCL, he has progressed to the point where he threw 25 pitches in an instructional league game last week and came away feeling healthy.

Here is a partial list of major league pitchers who have attempted platelet-rich plasma (PRP) and/or stem cell injections specifically for their UCL injuries (i.e. not flexor tendons or other parts of the arm or body).

MLB PITCHERS WHO HAVE TRIED PRP/STEM CELL INJECTIONS ON UCL Player PRP Injection Date Stem Cell Injection Date MLB Return Date TJ Surgery Date Injury Description Takashi Saito 7/1/08 9/15/08 Partial tear, starting to come off bone Carl Crawford 4/1/12 7/16/12 8/23/12 Partial tear Chad Billingsley 9/1/12 4/10/13 4/24/13 Partial tear Jonny Venters 6/1/14 9/17/14 Soreness during TJ rehab Masahiro Tanaka 7/14/14 9/21/14 Partial tear (10%) Tyler Thornburg 8/1/14 4/7/15 Weakness, slight tear (may be from 2004) Brandon Workman 4/15/15 6/15/15 Partial tear Alex Cobb 5/6/15 5/14/15 Partial tear Michael Lorenzen 4/1/16 6/24/16 Mild tear Andrew Heaney 5/1/16 7/1/16 Some degree of tear Sean Nolin 5/1/16 8/1/16 Partial tear Garrett Richards 5/16/16 Partial tear Jon Edwards 6/1/16 Wear Aaron Nola 8/17/16 Low-grade tear Colin Rea 8/18/16 Partial tear Rubby De La Rosa 7/1/16 9/27/16 Stretch

Clearly the results have been mixed, as some players have returned successfully after the injection and rest and rehab, some have returned but then shortly thereafter been re-injured, and others have not progressed well enough to return and ultimately required Tommy John surgery anyway.

Given that there is some level of success with these injections, and when successful they lead to quicker return times, I expect this trend to continue next season. The potential for success is also backed by this recent published article on the subject.

These injections are likely to be especially popular if a pitcher has a low-grade UCL injury, and even more so if that injury occurs at a time in the year where the potential of delaying surgery by a few months while a preferred alternative avenue is explored does not much impact the expected return date of the player.

Major League Pitchers

In the 2016 regular season, 742 players threw at least one pitch in a major league baseball game. Of those, 22 were position players mopping up in blowout games or forced into action in long, extra-inning affairs. Of the 720 true pitchers who appeared in a game this season, 190 have had Tommy John surgery. This group makes up 26.4 percent of all active major league pitchers.

In addition, 18 pitchers who ended the season on the major league disabled list but did not see any game action in 2016 have also had Tommy John surgery. These 18 made up 62.1 percent of pitchers who concluded the year on the DL without appearing this season, and when we include these pitchers to arrive at a percentage of all major league pitchers who have had Tommy John surgery, it brings the rate to 27.3 percent.

Here is a full list of major league pitchers who have undergone this surgery, broken down by team. Note that there are 13 pitchers who appeared for two teams during the season. These pitchers are listed for both teams, but counted only once in the major league total.

2016 PITCHERS WHO HAVE HAD TOMMY JOHN SURGERY, BY TEAM AND USAGE Team Pitchers Used Pitchers Pitchers Not Used, on DL Pitchers on DL Reds 13 Steve Delabar 0 Jumbo Diaz Josh Smith Dayan Diaz Alfredo Simon Layne Somsen A.J. Morris John Lamb Blake Wood Timothy Melville Matt Magill Homer Bailey Jon Moscot Athletics 11 John Axford 2 Jarrod Parker Andrew Triggs Felix Doubront Jesse Hahn Daniel Coulombe Rich Hill Ryan Madson Eric Surkamp Fernando Rodriguez Dillon Overton Raul Alcantara Chris Bassitt Royals 10 Edinson Volquez 1 Tim Collins Joakim Soria Danny Duffy Matt Strahm Alec Mills Brooks Pounders Luke Hochevar Kris Medlen Peter Moylan Jason Vargas Tigers 10 Anibal Sanchez 0 Dustin Molleken Logan Kensing Alex Wilson Shane Greene Drew VerHagen Jordan Zimmermann Mike Pelfrey Bruce Rondon Bobby Parnell Blue Jays 9 Jason Grilli 0 Scott Feldman Francisco Liriano Joseph Biagini Arnold Leon Dustin Antolin Drew Hutchison Gavin Floyd Roberto Osuna Braves 9 Jason Grilli 3 Paco Rodriguez Matt Marksberry Jesse Biddle Jason Hursh Andrew McKirahan Arodys Vizcaino Casey Kelly Eric O’Flaherty Chris Withrow Daniel Winkler Shae Simmons Giants 9 Albert Suarez 1 Ray Black George Kontos Josh Osich Hunter Strickland Matt Reynolds Cory Gearrin Matt Moore Derek Law Joe Nathan 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 0 Jo-Jo Reyes Fernando Rodney Dustin McGowan Wei-Yin Chen Bryan Morris Brian Ellington A.J. Ramos Jose Fernandez Pirates 9 Ryan Vogelsong 0 Mark Melancon Francisco Liriano Arquimedes Caminero Neftali Feliz Drew Hutchison Cory Luebke Jameson Taillon Ivan Nova Dodgers 8 Chin-hui Tsao 0 Hyun-Jin Ryu Adam Liberatore Alex Wood Rich Hill Brett Anderson Ross Stripling Brandon McCarthy Rockies 8 Jake McGee 1 Jairo Diaz Scott Oberg Jorge de la Rosa Justin Miller Jason Motte Jeff Hoffman Tyler Chatwood Adam Ottavino Angels 7 Al Alburquerque 1 C.J. Wilson Javy Guerra Andrew Bailey Cam Bedrosian Tyler Skaggs Andrew Heaney Nick Tropeano Diamondbacks 7 Keith Hessler 0 Andrew Chafin Rubby de la Rosa Kyle Drabek Daniel Hudson Patrick Corbin Vicente Campos Nationals 7 Mark Melancon 1 Aaron Barrett Shawn Kelley Stephen Strasburg Koda Glover Sammy Solis Lucas Giolito Sean Burnett Phillies 7 Andrew Bailey 0 Alec Asher Elvis Araujo Vincent Velasquez Charlie Morton Frank Herrmann David Hernandez Rangers 7 Colby Lewis 0 Shawn Tolleson Matt Bush Sam Dyson A.J. Griffin Martin Perez Yu Darvish Astros 6 Scott Feldman 0 Tony Sipp Kevin Chapman Pat Neshek Will Harris David Paulino White Sox 6 Miguel Gonzalez 0 Michael Ynoa Scott Carroll Matt Purke Nate Jones Daniel Webb Yankees 6 Kirby Yates 1 Nick Rumbelow Conor Mullee Nicholas Goody Ivan Nova Branden Pinder Nathan Eovaldi Mets 5 Erik Goeddel 1 Zack Wheeler Jacob deGrom Steven Matz Matt Harvey Josh Edgin Padres 5 Matt Thornton 1 Carter Capps Fernando Rodney Keith Hessler Leonel Campos Robbie Erlin Rays 5 Eddie Gamboa 0 Tyler Sturdevant Matt Moore Alex Cobb Chase Whitley Cardinals 4 Seung Hwan Oh 1 Lance Lynn Miguel Socolovich Jaime Garcia Adam Wainwright Twins 4 Andrew Albers 0 Kyle Gibson Alex Wimmers J.T. Chargois Brewers 3 Wily Peralta 1 Sean Nolin Chris Capuano Sam Freeman Cubs 3 Hector Rondon 1 Dallas Beeler John Lackey Joe Nathan Orioles 2 Brian Duensing 0 Dylan Bundy Mariners 3 Adrian Sampson 1 Charlie Furbush Arquimedes Caminero Joe Wieland Red Sox 2 Junichi Tazawa 1 Brandon Workman Carson Smith MLB 190 18 Percentage 26.40% 62.10% Overall 27.30%

MLB Games

With more than a quarter of all pitchers having had UCL reconstruction surgery, and ever-growing bullpen specialization increasing the number of pitchers used in each game, it seems not a game goes by where broadcasters aren’t mentioning the surgery in discussing a player as he works from the mound.

In fact, I calculated the percentage of regular season major league games in 2016 featuring at least one pitcher who has had Tommy John surgery, and the result was a quite staggering 86.4 percent! This means on a typical night with all teams in action, you could expect that 13 out of the 15 games will involve a pitcher whose career has been extended with the help of this surgery.

I know there are fans who lament how often broadcasters mention Tommy John surgery, but at least it is apparent just how often pitchers dealing on your screen have undergone this procedure. Here is the breakdown by team of how many games this season they played in which one or more pitchers (on that team or the opponent’s team) have had Tommy John surgery.

2016 REGULAR SEASON, TEAM GAMES INVOLVING PITCHER WHO HAS HAD TJ SURGERY Team TJ Games TJ Games % Indians 158 98.1% Marlins 157 97.5% Athletics 157 96.9% Royals 154 95.1% Rockies 154 95.1% Rangers 153 94.4% Tigers 152 94.4% Nationals 152 93.8% Cardinals 151 93.2% Braves 150 93.2% Phillies 149 92.0% Giants 149 92.0% Mets 148 91.4% Astros 148 91.4% Pirates 146 90.1% Diamondbacks 143 88.3% Reds 143 88.3% Blue Jays 142 87.7% White Sox 141 87.0% Angels 133 82.1% Cubs 130 80.2% Dodgers 130 80.2% Padres 129 79.6% Twins 125 77.2% Yankees 124 76.5% Red Sox 120 74.1% Orioles 118 72.8% Brewers 118 72.8% Mariners 114 70.4% Rays 110 67.9% MLB 4,198 86.4%

Note that Cleveland played only 161 regular season games this year, meaning the Indians finished only three games all season in which no pitcher appeared who’d had Tommy John surgery. Those games were June 11 at the Angels, then back-to-back on June 21 and June 22 versus the Rays. In those latter games, the Indians received complete game efforts from Corey Kluber and Trevor Bauer, helping to reduce the total number of pitchers entering the game and hence the likelihood of involving one who’d recovered from a UCL reconstruction.

Major League Returns

There were 20 players who returned to the majors this season after playing their last game prior to Tommy John surgery at the major league level.

2016 RETURN TO MLB AFTER TJ SURGERY Player Position Return Date Recovery Time (months) Tyler Chatwood P 4/6/2016 20 Cory Luebke P 4/7/2016 47 (1st), 26 (2nd) Dylan Bundy P 4/7/2016 33 A.J. Griffin P 4/8/2016 23 Chris Withrow P 4/10/2016 22 Christian Vazquez C 4/15/2016 12 Yu Darvish P 5/28/2016 14 Brandon McCarthy P 7/3/2016 14 Adam Ottavino P 7/5/2016 14 Don Kelly OF 7/6/2016 12 Joe Nathan P 7/24/2016 15 Tyler Skaggs P 7/26/2016 23 Homer Bailey P 7/31/2016 15 Josh Edgin P 8/3/2016 17 Frank Herrmann P 8/17/2016 41 Shae Simmons P 9/1/2016 19 Alex Cobb P 9/2/2016 16 Sean Burnett P 9/3/2016 27 Chase Whitley P 9/11/2016 16 Jason Vargas P 9/17/2016 13

Cory Luebke returned to the majors close to four years after his original Tommy John surgery failed: The tendon graft became “yellow and mushy,” forcing him to undergo a revision surgery and restart his rehab clock. Frank Herrmann is also a nice story, finally getting back to the bigs after more than three years and time spent at Triple-A in four different organizations.

Jason Vargas returned just days early enough to break a trend that I’d noticed in recent seasons: Starting pitchers have not been returning until 14 months or more (rounded to the closest month) after having Tommy John surgery. Here are the numbers by year of surgery:

RETURN TO MLB AFTER TJ SURGERY FOR STARTING PITCHERS Year of TJ 13 months or fewer 14 months or more 2015 1 5 2014 0 11 2013 1 5 2012 7 9 2011 4 3 2010 2 2 2009 4 3

Only two pitchers (Gavin Floyd and Jason Vargas) out of 22 who were major league starting pitchers at the time of their Tommy John surgery since the start of 2013 have returned to the major league level in fewer than 14 months. This represents just 9 percent of all starting pitchers who had the surgery between 2013 and 2015. By contrast, 50 percent of starting pitchers who had the same surgery between 2009 and 2012 returned in 13 months or fewer.

This 2013-2014 period roughly lines up with a time in which multiple major league pitchers were forced to undergo quick second Tommy John surgeries (Daniel Hudson, Cory Luebke, Brandon Beachy, Jarrod Parker, Jeremy Hefner, Kris Medlen and Jonny Venters twice). Perhaps organizations (and agents) put the brakes on rehab schedules in response, in an effort to prevent revision surgeries for their players.

References & Resources