Major Leaguers’ Tommy John Surgeries Trending Down

Garrett Richards is attempting to avoid Tommy John surgery with a PRP injection. (via Keith Allison)

Garrett Richards is attempting to avoid Tommy John surgery with a PRP injection. (via Keith Allison)

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


Jon Roegele is a baseball analyst and writer for The Hardball Times. He was nominated for a SABR Analytics Conference Research Award in 2014 and 2015. Follow him on Twitter @MLBPlayerAnalys.
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JaysCraze
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JaysCraze

I only really know the story of how the Jays got their pitchers, but it seems like only Hutchison (now former Jay) was homegrown- though I’m not sure when he had his. I believe Osuna had his before he came to the Jays. Everyone else had theirs before coming to the Jays.

Could the Jays know something no one else does? Or just luck of the draw?

JaysCraze
Guest
JaysCraze

Antolin too- don’t know my prospects like I should.

Eric R
Guest
Eric R

Is there another Carl Crawford, that I can’t find on baseball-reference, who was a pitcher?

Jon Roegele
Guest

No you’re right he’s the outfielder. That table should say MLB Players. But he did have a PRP injection, and ultimately had Tommy John surgery.

Aaron
Guest
Aaron

Wow. I totally forgot about Jonny Venters.

Kevin
Guest
Kevin

Is it a coincidence that the Biogenesis scandal broke in 2013, or could alternative treatments have shortened the rehab times for surgery in the 2009-12 sample?

MG
Guest
MG

The article headline is misleading. There needs be to at least another year to really make any statement about what direction the rate of surgeries is headed.

Pirates Hurdles
Guest
Pirates Hurdles

Completely agree, article shows 2016 was a down year, but rates seem to be mostly random noise, certainly not a trend towards decreasing. The Pearson R value is 0.2675 which is not significant but actually suggests a increasing trend over the 10 years mentioned.