NEW YORK — Last spring, Sandy Alderson bemoaned the lack of information on the causes of elbow injuries. As baseball was struck by a particularly gnarly run of pitchers who would have to undergo Tommy John surgery — some for a second time — the Mets embarked on their season without Matt Harvey, who was recovering from his own procedure. It was, for the Mets general manager, another flashpoint in the need for data.

For Major League Baseball, that call had already been heard. Last spring, it conducted its first collaborative study on the cause of elbow injuries that lead to the infamous surgery, with the Yankees among those involved. This season, it has begun one on a wider scale, with a long-term scope, and the Mets are leading the effort.

The Mets are among five teams that have agreed to allow the use of their pitchers taken in the 2014 draft to be involved in a study that is being run in accordance with MLB and the players association, as well as the American Sports Medicine Institute. While the Mets are involved in the pilot year, those in charge of research hope to eventually expand to all minor league pitchers and each team.

"We as an industry probably should have taken the initiative long ago before this became such an epidemic," Alderson said. "But I'm happy we're pursuing it now. That, I think, will help us with the next generation of baseball pitchers."

The study is the latest turn by baseball to solve a problem that has come without a solution so far. With a reliance on pitch counts, innings limits, incremental developmental curves and any number of measures, baseball has tried to save itself from these elbow woes.

But now, with underwhelming results, paucity of data and not enough reliable underlying information, it is turning to science.

And as they hope to learn more about the causes of Tommy John surgery, options to mitigate its costs are also popping up. While ASMI — run by famed orthopedic surgeon Dr. James Andrews — is helping run the study, one of the doctors he works with is also helping pioneer a surgery that could severely cut the rehab and return period from torn ulnar collateral ligaments.



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Last March, in eight spring training camps around baseball, including the Phillies and Yankees, 80 pitchers — 40 with no history of ulnar collateral ligament reconstruction and 40 with one — were stamped with 23 reflective markers and threw 10 fastballs at full effort as 10 cameras tracked and analyzed their movement.

It was the first attempt by Major League Baseball, the players association and ASMI to learn if there was a bio-mechanical underpinning to pitchers that eventually had to have Tommy John surgery and those that had avoided it to that point.

The study found no link. The results were hardly dispositive and the research itself was just an initial step for the group.

This spring, trio began collaboration on another project. It is a prospective study that will last five years. This year, it will include every first-year pitcher in five organizations, including the Mets.

"We just needed more information," Dr. Gary Green, MLB's chief medical officer, said. "Obviously this is an area of concern. So when you don't know the answer to a question, you have to go back and see how do we design a study to answer some of the questions that we'd like to find about that are important to baseball?"

The survey will examine the pitchers' biomechanics, their anatomy, flexibility, and see if it can identify the risk factors that make some more susceptible to elbow injuries than others.

By tracking the pitchers from the beginning of their professional careers, the study can also follow them if they do get hurt and through recovery. Green expects the answers to be varied.

"That the elbow ligament, when it tears, is the end result of multiple processes," he said.

"We're not going to find one unifying theory. My guess is it's multiple factors."

The conclusions, whatever they may be, will be shared with all 30 teams. Green hopes that the full five-year window will not have to go by for answers and data will be reviewed annually.

For the Mets, the decision to participate was not difficult. Alderson has long been a proponent for this type of action.

"We collaborate with anybody that's looking into these topics," he said.

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As baseball tries to learn more about what leads to Tommy John surgery, Green hopes the inquiry will also produce answers on how to proceed when pitchers learn that surgery is needed.

He looks at the relatively significant depreciation in shoulder surgeries and seems a model for what can possibly happen with elbow injuries. He wants to answer the question of who should and should not have surgery.

"We don't have a good answer as to who should have surgery, who should do rehab and other types of non-operative treatments," Green said.

Jeff Dugas is also trying to answer that question as well. A surgeon at Andrews Sports Medicine & Orthopaedic Center, he is performing a new surgical approach to torn ulnar collateral ligaments that could potentially cut down the recovery period for pitchers by at least six months.

Generally, pitchers who need Tommy John surgery fall into two categories: Those have partial tears of their UCL and those that have full tears. For those with full tears, like Zack Wheeler, surgery is unavoidable.

But for those with partial tears, like Matt Harvey and Masahiro Tanaka, who sometimes try rest and rehab before settling for surgery, Dugas believes he has a possibly less invasive option.

"They get to us because they can't pitch and they can't throw. Are we doing too much of an operation - the same operation - We're doing one operation for all different pathologies," he said. "We've got full thickness tears that are having Tommy John surgery and we've got guys with partial thickness tears that are having Tommy John surgery and everything in between. So we started thinking about maybe we're doing too much surgery for some of the ones we've seen. And is it possible to repair what's there?"

Dugas' solution is a surgery that uses collagen-dipped super-tape. "Strong enough to tow a car with, basically," he says. The tape is then attached to each end of the ligament and to the bone with an anchor, repairing the UCL back to where it tore off.

He believes this surgery can become an alternative to full UCL reconstruction. When Dr. Frank Jobe first embarked upon the quest to repair torn ligaments, repairs had a far worse success rate than reconstruction, results that Dugas thinks have made that option unpalatable.

Instead, he sees a similarity in how medicine now treats ligament damage in knees, shoulders and ankles.

"Could we repair this with modern technology and do a little better?," he said. "There's been some technology changes that make the answer to that question certainly possible."

So far, Dugas has performed this kind of surgery only 30 times over the past 20 months and not each patient has been a pitcher. They have also primarily been high school and college players. But all have returned to their same baseline performance in six months and with full range of motion.

"This is so early I'm being cautious not to tout this as the second coming," Dugas said. "This is definitely early in the process and they could all fall apart tomorrow but the early data is very promising."

Until there is more data, Dugas is hesitant to perform it on professional pitchers. Still, he saw enough positive signs. In 2-3 years, it may become feasible.

It is, possibly, another step forward for a sport looking to give itself solutions and answers to an unwavering problem.

Mike Vorkunov may be reached at mvorkunov@njadvancemedia.com. Follow him on Twitter @Mike_Vorkunov. Find NJ.com Mets on Facebook.

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