Archives for January 2017

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.