Tony Gonsolin and Current Tommy John Surgery Traits

Between Shohei Ohtani, Félix Bautista, and now Tony Gonsolin, the fragility of ulnar collateral ligaments has been an all-too-frequent matter of dialog inside the previous week. Gonsolin, in case you haven’t heard, is headed for Tommy John surgical procedure on Friday, whereas we’re nonetheless ready to listen to whether or not the UCL accidents of Ohtani and Bautista are vital sufficient to advantage going underneath the knife. Between that trio and the Rays’ Shane McClanahan taking place earlier this month — and the truth that neither Gonsolin nor McClanahan are the primary members of their groups’ rotations this yr to want such surgical procedure — it definitely feels as if we’re coping with lots of Tommy Johns recently, so it’s value slicing by the numbers.

First, nonetheless, let’s spare a number of paragraphs for Gonsolin and the Dodgers. The 29-year-old righty was coming off an All-Star season during which he posted a 2.14 ERA and three.28 FIP in 130.1 innings, and owned equally spectacular profession marks (2.51 ERA, 3.45 FIP) regardless of his intermittent availability as a result of accidents, which included a six-week absence close to the top of final season as a result of a forearm pressure, and simply two appearances totaling 3.1 innings afterwards, one in all them a four-out begin within the 2022 Division Series. After spraining his left ankle throughout fielding drills in early March, he was taking part in catch-up and by no means appeared to discover a consolation zone. He started the common season on the injured checklist, lastly debuting on April 26, and whereas his run prevention numbers regarded good within the early going, his peripherals advised one other story, and his common fastball velocity was down. On June 11, supervisor Dave Roberts alluded to some well being points with Gonsolin, noting that his between-starts restoration “hasn’t been great,” and questioning if he was having hassle getting unfastened or pacing himself. In his subsequent begin two days later, Gonsolin threw six shutout innings however averaged simply 91.1 mph together with his four-seamer, two full ticks beneath final yr.

To that time, Gonsolin had a 1.93 ERA however a 4.25 FIP, and shortly he started to get roughed up on a routine foundation. Over his subsequent seven begins, he allowed 4 or extra runs six instances, producing a 7.25 ERA. Following a 3.1-inning, five-homer, 10-run stinker on August 18, Gonsolin’s second unhealthy begin out of three, Roberts advised reporters that Gonsolin had been pitching by an unspecified “arm issue” for 4 to 6 weeks and would probably head to the injured checklist. On Sunday, the Dodgers acknowledged that surgical procedure was an choice, and on Monday it was revealed he’d bear Tommy John on September 1.

Gonsolin had apparently been pitching by a UCL tear, one thing he and the Dodgers knew primarily based on imaging accomplished after that June 13 begin. Mindful of the concurrent losses of Dustin May and Julio Urías to the IL, Gonsolin elected to pitch by the harm. “I was just hoping I could make it through the season, put up good numbers and just post,” he advised reporters. “I thought I had full capability to do that.”

Gonsolin did have monetary incentives to intestine it out, and the Dodgers let him accomplish that. Via the two-year, $6.65 million extension he signed in January, he earned one level for each begin or aid look of no less than 3.1 innings. For reaching 14 factors, he added $500,000 to subsequent yr’s base wage of $3.4 million, with further will increase of $500,000 apiece for reaching 16, 18, 20, 24, and 28 factors. That 3.1-inning shellacking bought him to twenty factors, that means that he’ll make $5.4 million subsequent season whereas rehabbing after surgical procedure. He’ll have two years of membership management remaining after that.

With May out as a result of his personal Tommy John surgical procedure — his second, alas — the lack of Gonsolin leaves the Dodgers with a rotation of Urías, Clayton Kershaw, Lance Lynn, and rookies Bobby Miller and Ryan Pepiot. Kershaw remains to be constructing his pitch rely again up following a six-week absence as a result of shoulder soreness. Urías has not had his sometimes sturdy season, posting a 4.41 ERA and 4.43 FIP. Lynn has improved significantly since being acquired from the White Sox on the commerce deadline, utilizing a brand new pitch combine to put up a 2.03 ERA in 5 begins for Los Angeles in comparison with a 6.47 mark for Chicago. Miller, the staff’s prime pitching prospect, has been dazzling at instances however has additionally spiraled his approach into massive innings; he has a 4.00 ERA and three.64 FIP. Pepiot has solely pitched thrice for the Dodgers this season after lacking the entire first 4 and a half months as a result of an indirect pressure; Wednesday night time’s begin towards the Diamondbacks was his first main league begin since final August 21. Deadline acquisition Ryan Yarbrough is a bulk various, whereas Gavin Stone and Emmet Sheehan are again at Triple-A Oklahoma City after taking their lumps for the Dodgers. Walker Buehler, who’s rehabbing his approach again from his second Tommy John surgical procedure, has but to throw greater than an inning at a time on the Dodgers’ coaching complicated, and isn’t more likely to be constructed as much as a starter workload by the point the playoffs roll round.

Unless Urías recovers his kind, that doesn’t precisely seem like the makings of an imposing postseason rotation. The even greater query is what occurs subsequent yr on condition that he, Kershaw, and Lynn are all poised totally free company, although the final of these pitchers has an $18 million choice. The Dodgers ought to have Buehler again in working kind, and definitely a few of the younger arms they’ve proven off as nicely, however they’ll want some veterans to stabilize the unit and on the very least eat innings. That Kershaw will finish this season 40 or 50 strikeouts wanting 3,000 may assist incentivize his return to the fold, as he’d look very bizarre celebrating that career-capping milestone as a Texas Ranger (and haven’t the Rangers spent sufficient on pitching recently?).

All of these are issues for an additional day. As for the subject of UCL reconstruction, in response to Jon Roegele’s Tommy John Surgery Database, Gonsolin would be the twenty second main league pitcher to bear the process this yr, a rely that doesn’t embrace Ohtani or Bautista, whose programs of motion have but to be decided. Here’s how the numbers examine over the previous decade and a half:

A caveat right here: While the drop-off in skilled pitchers present process the surgical procedure this yr seems to be encouraging, I wouldn’t take the present rely as gospel; minor league accidents are usually underreported on the whole, and sometimes with delays concerned. When I look again at previous variations of this train, it’s clear a few of the annual numbers have grown. The main league totals I’d regard as complete, nonetheless — it’s robust to overlook these.

Anyway, on the main league stage, this yr’s complete of twenty-two TJs together with Gonsolin is down from final yr’s 26, although in fact we may nonetheless see extra earlier than the top of the yr. We’re nonetheless nicely beneath the single-season excessive of 35, set in 2012, and the spike to 31 in ’21, which probably owed one thing to pitchers ramping up after the pandemic-shortened season. The downward development since 2021 is offset by the truth that the four-year common of 27 is the best it’s been since 2012–15 (additionally 27), and it’s nearly definitely destined to go larger; final yr there have been 5 TJs after September 1, whereas in 2021 there have been 4.

Having stated that, I don’t see something but to recommend that the brand new pitch clock rule is resulting in any sort of spike in TJs (there have been a handful of articles in May and June exploring the query). It is notable that the severity of pitcher accidents — as in, longer stays on the IL, even after accounting for the rise within the minimal stint from 10 days to fifteen — has risen over the previous couple of seasons in response to Baseball Prospectus’ Derek Rhoads and Rob Mains. “Compared to 2021, the increase in average IL stint for pitchers this year from the start of the season this year is 5.4 games through July 31 and 5.3 games through the 124th day.” (The 124th day this yr was July 31, however the authors are simply overlaying their bases to account for final yr’s lockout). Additionally, Rhoads and Mains introduced a graph exhibiting that the share of pitcher ILs keep lasting 25 days or longer crossed the 50% threshold final yr and that eyeballs someplace within the mid-50s now. Still, it’s value remembering that, as longtime massive league athletic coach turned analyst Stan Conte advised MLB.com’s Anthony Castrovince, “[The injured list] is a roster management tool, not an injury database.” With TJs, now we have some accounting to fall again upon.

The Dodgers aren’t the one staff to lose two of their prime starters to TJ this yr. The Rays misplaced Jeffrey Springs in May, earlier than shedding McClanahan, and I’m not even counting Drew Rasmussen, who underwent the UCL inner brace process — which takes much less time to return from however is way much less widespread — in July. The Rockies misplaced each Germán Márquez and Antonio Senzatela, whereas three different groups have misplaced two main league pitchers to TJ this yr, specifically the Angels (José Quijada and Austin Warren), Reds (Connor Overton and Reiver Sanmartin), and Twins (José De León and Tyler Mahle). Fifteen groups haven’t misplaced anybody on the main league stage this yr, fortunately.

With Ohtani’s destiny within the steadiness, with May and McClanahan each having undergone their second TJs, and with Buehler working his approach again from his second, I did some analysis into their frequency as nicely. At the main league stage, two different pitchers have gone again for seconds this yr, specifically Trevor Rosenthal, who hasn’t pitched within the majors since 2020 as a result of different accidents, and Jacob deGrom, who was simply six begins into his $185-million contract when his elbow lastly gave approach.

As you may surmise from the pandemic-era wave of TJs, we’re seeing an growing variety of revisions on the main league stage, although we’re nonetheless speaking fairly small numbers. Here’s the identical interval from the graph above, damaged into first-timers and second-timers (or, within the circumstances of Jason Isringhausen and Jonny Venters, third-timers):

Back in 2014, a large group of 11 pitchers underwent a second (or within the case of Venters, third) TJ, and by and huge, the outcomes have been bleak. Four of them (Pedro Figueroa, Jeremy Hefner, Jarrod Parker, and Josh Johnson) by no means pitched one other massive league sport, and three others barely made a dent: Brandon Beachy solely made two extra appearances however was nonetheless making an attempt to return again as late as 2019, whereas Sean Burnett and Cory Luebke every made 10 or fewer further main league appearances. Venters, Tyler Chatwood, Kris Medlen, and Peter Moylan have been the success tales in that they every returned to pitch in a number of seasons, however their post-second TJ careers have been restricted in influence.

Return charges have improved since then, in that 13 of the 18 pitchers to bear a second TJ within the 2015-20 span made it again to the majors, with Mike Clevinger (2020), Nathan Eovaldi (2016), and Jameson Taillon (2019) all sticking in rotations for a number of seasons. Eovaldi and Taillon each pitched nicely sufficient to web profitable free agent offers, and Eovaldi has since made two All-Star groups. Another pitcher from that span, Caleb Ferguson, has emerged as a mainstay within the Dodgers’ bullpen.

One factor that separates that 2015-20 group from the Class of 2014 is longer timespans between surgical procedures. The 11 pitchers from 2014 averaged solely 4.5 years between surgical procedures, with Beachy, Hefner, Luebke, and Venters every needing a follow-up inside two years; solely Burnett and Chatwood went greater than seven years between. From the 2015-20 group, the typical is as much as 5.9 years, with solely two pitchers needing a revision inside two years (Tim Collins and Joel Hanrahan). Of the 4 from that group who went greater than seven years between surgical procedures, two of them have been Clevinger (8.3 years) and Eovaldi (9.2 years), however of the opposite two, Edinson Volquez (8.0 years) and Sam Freeman (10.2 years), the previous made simply 18 extra appearances with ERAs above 6.00, whereas the latter by no means returned to the majors.

At this writing, I’ve not accomplished the total math on earlier than/after efficiency comparisons, or in contrast the surgery-to-return intervals of the successes to the remainder, however someday after 2014, groups realized that returns from second surgical procedures wanted extra time than the standard 13-15 months for first surgical procedures. To cherrypick a number of knowledge factors, Clevinger (18 months to return to the majors), Eovaldi (21), Ferguson (20) and Taillon (20) mirror this adjustment in pondering, however then so did Volquez (20). Via a 2020 paper within the Orthopaedic Journal of Sports Medicine that synthesized the outcomes of 29 earlier research that met their methodological requirements, we do have some systematic accounting to go by:

After main UCLR [ulnar collateral ligament reconstruction], Major League Baseball (MLB) pitchers returned to play in 80% to 97% of circumstances in roughly 12 months; nonetheless, return to the identical stage of play (RTSP) was much less frequent and took longer, with 67% to 87% of MLB pitchers returning in about 15 months. RTP charges for MLB pitchers after revision UCLR have been barely decrease, starting from 77% to 85%, whereas RTSP charges ranged from 55% to 78%… All research discovered a lower in pitching workloads after UCLR. Fastball utilization might also lower after UCLR. Changes in earned run common and walks plus hits per inning pitched have been inconclusive.

Based on Roegele’s knowledge, no pitcher has returned from even a primary Tommy John surgical procedure in lower than 13 months for the reason that Cardinals’ Dakota Hudson, who did so in 362 days (from September 28, 2020 to September 4, 2021), which is why what Buehler and the Dodgers are doing almost about his second surgical procedure (which came about final August 22) feels extremely dangerous. Hyun Jin Ryu returned from his second surgical procedure in 13 1/2 months, however he additionally went a report 18 years between surgical procedures, and cashed in by way of an $80 million free agent contract signed in December 2019. Buehler is making $8.025 million in his penultimate yr of membership management, and thus placing a really massive multiyear payday on the road by dashing again. For his sake, I’d slightly see the Dodgers throw the brakes on his return, significantly given what we find out about the influence of excessive velocities on UCLs.

As for more moderen revision recipients, Ryu is one in all simply three pitchers (out of 14) who has undergone a second TJ for the reason that begin of 2021, and he has all of 5 begins underneath his belt, although he’s pitched fairly nicely. Of the opposite two, Kirby Yates, who had his revision accomplished in March 2021, is having a stable season within the Braves’ bullpen, whereas John Curtiss, who had his in September ’21, made simply 15 main league appearances for the Mets earlier than just lately present process surgical procedure to take away unfastened our bodies from his already-scarred elbow.

Of the remainder, there are a number of hopeful tales. Chris Paddack, who had his second surgical procedure on May 18, 2022, has a rehab project lined as much as begin on September 6, with hopes of returning later within the month. The Reds’ Tejay Antone — the title is a bit on the nostril on this context — had his revision on August 27, 2021; he battled further elbow troubles earlier within the season however has made 14 minor league rehab appearances, the latest one on Wednesday with Triple-A Louisville. Hopefully he may return in September as nicely. Joe Ross, who had his revision in June 2022, has made three minor league appearances for the Giants up to now 10 days, whereas Brandon Bailey, who had his second TJ in February ’21, has two minor league appearances within the White Sox group this month in his first sport motion since ’20. John Axford, who went practically 18 full years between his first and second surgical procedures, pitched for Team Canada within the World Baseball Classic, however whereas the 40-year-old righty has not formally retired, he’s unsigned.

If Ohtani performs out the remainder of the season earlier than present process his second TJ (assuming his tear is extreme sufficient to advantage it, which is an unknown) in October, presumably he received’t pitch in any respect till 2025. That would give him no less than 18 months between surgical procedure and return, and given the {dollars} — and velocity — at stake, it wouldn’t be a shock if he waited longer.

Because of the stresses that repeated high-intensity throwing locations on arms, Tommy John surgical procedures are an inevitability inside baseball. Within the info, we’ve no less than begun to see indicators of groups studying to not rush TJ recipients again to the majors. That’s small progress, however it’s one thing to hold onto, no less than.