Former Cardinals reliever Seth Maness underwent elbow surgery in mid-August; he was ultimately non-tendered and remains a free agent. But there’s more to the story, as Derrick Goold of the St. Louis Post-Dispatch reports in a piece that demands a full read.
As Goold documents, Maness underwent a somewhat experimental “primary repair” procedure to his ulnar collateral ligament that could allow him to return by the start of the 2017 season. If it works, the surgery will potentially save Maness from the lengthy and uncertain process of rehabbing from a UCL replacement — what’s commonly known as Tommy John surgery.
Maness, 28, became the first current MLB pitcher to undergo this particular procedure. Doctors cannot determine whether the less-demanding approach is feasible until they have opened the patient’s elbow. But if the UCL is in good enough shape, and the location of the tear is appropriate, then the “UCL repair with internal brace construction” can be attempted in lieu of utilizing a donor ligament for a full replacement.
If it’s achievable, the repair effort has the potential to shave significant time off of the rehab process for a pitcher. In Maness’s case, he’s on track to take the mound later this week (within five months of his surgery) and perhaps return to major league action by Opening Day (i.e., about seven and a half months from the date of the procedure). That’s well short of the year-plus rehabilitation timeline required for a typical, first-time TJ patient.
“It has that potential to be big,” said Dr. George Paletta, the surgeon who worked on Maness’s elbow. Other medical and industry figures who spoke with Goold — including Dr. Jeffrey Dugas, who also performs this surgery — similarly described the primary repair procedure in those guardedly optimistic terms. While there’s still a need for sufficient observable data, initial results from lower-level pitchers have been promising. (In other words, Maness isn’t exactly serving as a guinea pig.)
Goold details the current findings, and you’ll want to read his exhaustive piece for the full scope. The takeaway, though, is that pitchers who have qualified for and received this TJ alternative have generally shown a strong track record of returning to competitive action in about six and a half months, with none requiring subsequent re-repairs or TJ procedures.
Needless to say, the possibility of a new approach for at least some pitchers with UCL tears — an all-too-common problem in today’s game — holds out significant hope. While the legendary TJ procedure offers a path back for hurlers who once would’ve seen their careers fully derailed, it continues to be a long road that can’t be completed by all who take it.
There have been other efforts, too, that are also worth following. Angels starter Garrett Richards is perhaps the primary example of therapy attempts being undertaking to stave off surgery of any kind. He is currently slated to report for a full Spring Training after receiving platelet-rich plasma and stem-cell treatments on his injured right elbow.
All eyes will be on both Maness and Richards — among others — as they seek both to resume their own careers and provide a new way forward for injured pitchers. Assessing the efficacy of these approaches, refining the methods, and determining when to deploy each of the possible strategies will no doubt continue to be a work in progress. But adding less-drastic alternatives to the classic Tommy John surgery could potentially go a long way toward allowing players to maintain their career paths while protecting teams’ personnel investments.
Beyond the obvious, these new approaches also present the possibility of creating more proactive ways of dealing with elbow problems. Indeed, as Paletta tells Goold, the primary repair surgery might allow for greater confidence in “moving to surgery early on,” and the same might well hold of the treatment approaches. Rather than pitching through pain, or just resting and hoping, at least some pitchers may one day be able to turn to these new techniques — if they’re proven to work — before it becomes necessary to undergo a full UCL replacement.
Of course, it’s still preferable to forestall the necessity of these less-invasive approaches, even if they are shown to be effective. With so many valuable pitchers succumbing to Tommy John surgery, MLBTR and contributor Bradley Woodrum undertook a study last winter to assess the statistical likelihood of future UCL replacement. Though the identified risk factors account for only a small portion of the risk for a given pitcher, that study (and future efforts) may also help organizations and their medical staffs seek ways to maintain elbow health.
Are they trying to put Dr James Andrews out of business?
He performs more than just TJ surgeries. And even if they were, I don’t think him (or the next generation of his family) will notice too much.
I’m also sure that he’s capable of doing the new surgery too, then he would just become the go to guy for that too
He better step up his game!
The first surgery of this type was performed by Dr. Jeffrey Dugas, managing partner of the Andrews Sports Medicine & Orthopedic Center founded by Dr. James Andrews.
stltoday.com/sports/baseball/professional/maness-a-trailblazer-new-surgery-for-elbow-repair-cut-recovery/article_165ee721-5a36-58f9-8d8e-fb515ba037da.html
I don’t think the procedure done on Maness is necessarily the same as the one being done by Dr Dugas at Andrews (Dugas calls his the “UCL repair with internal brace construction”). The methods sound similar, but were developed separately, so I am sure there are subtle, yet significant differences in how they are performed.
It is important to note that this is not a replacement for TJS in most cases, but kind of a “middle road” for those with their ulnar collateral ligament still relatively intact.
I’m very interested in the paper that Dr Paletta is working on. The problem with these types of specialized procedures aimed at professional athletes is that it takes so long to build up a meaningful sample size, that it takes forever to really prove the efficacy and safety of the procedure.
Andrews already has a guy who does the repair procedure.
Since Dr. Andrews is 74 and well paid over the years, I doubt he’s too concerned about it.
Us Schwarbers are platelet-rich… that’s how my Kyle healed so fast!
Or maybe PED’s….or it’s a standard return from that type of injury (likely the latter)
Going under for Seth Maness surgery just doesn’t have the same ring to it as Tommy John surgery. Maybe SethMan Surgery will stick.
In 10 years will we be talking about the Seth Maness Surgery plague that is enveloping MLB pitchers?
Good thing Mark Rzepczynski wasn’t the first pitcher to go through this procedure.
It’s a good thing Garrett Richards has made $10 MM. Unlike his distant cousin Kelly, he shouldn’t have the need to make $8K a month online from home!
And unlike Kelly, he draws rave reviews.
Since Maness wasn’t the first one to undergo this type of surgery, who is it going to be named after?
Would have been nice if the article had included the name of the “lower-level” pitcher who was the first one.
Love the article, and really hope that both Maness and Richards can avoid TJS. The former represents an intriguing incentive-based free agent and if both can make it back, this could be huge for pitchers in general.
Tommy John Surgery filters out the weak arms
But who filters out the weak posts?
Actually just had this surgery on my left elbow myself, I’m two months removed and I should be able to throw again in roughly two months from now, and play again by the summer. (I’m in college) Dr. James Bradley did my surgery at UPMC St. Margaret’s in Pittsburgh.
Hi Can you tell me please if you had pain during the throw program. thanks
Sorry I did not see your comment until just now. I didn’t have any sharp pains. All I had during my throwing program was soreness.
Seth was a ground ball machine. I can remember him coming in late in the game with Bases Loaded numerous times and one out and him inducing several double plays and getting the Cardinals out of trouble and either keeping their lead or keeping the game tied. I hope this surgery works out well for him and only wish him the best.
Please can you give your opinion if you’ve had this. I am a Mom. My son had this surgery. He is currently experiencing pain during throw program. He had therapy. Dr keeps saying it is muscular but i do not feel comfortable letting him throw with sharp pain.
I am returning to the dr for the 3rd time with this concern. Did anyone else have when throwing after warm up when extend full arm in throw. Then it goes away and returns with throwing thank you