On Tim Lincecum and Labral Tears

Tim Lincecum's hip injury has kept him out of action since the end of June. (via Dirk Hansen)

Tim Lincecum’s hip injury has kept him out of action since the end of June. (via Dirk Hansen)

Labral tears are, thankfully, relatively uncommon in major league baseball. Less well known than UCL tears—the injury that necessitates Tommy John surgery—these injuries require a very complex surgery, extensive rehab, and can end a pitcher’s career. Pitchers like Michael Pineda have made it back to the majors after their labral tears, but they are the minority and even those who make it back can miss multiple seasons recovering. So why has there been an increase in labral tears, which come with a three-to-six month recovery window attached to them?

While typically used to describe the cartilage between the shoulder socket and the upper arm, the term “labrum” can also be used when talking about the connective tissue between the upper leg and the hip socket. So while a tear of the labrum in the arm (the glenoid labrum) can end a career, a tear of the labrum in the leg (the acetabular labrum) has a much shorter return-to-action timeline.

If it feels as though this type of injury has happened more often recently, that’s because it became an available diagnosis only within the last 15 years; an impingement known as FAI (short for Femoroacetabular impingement) is what typically causes the labral tears, and it has been popularly diagnosed and treated via arthroscopy only since the early 2000s. While a player could theoretically tear his labrum traumatically, it’s far more likely to be a chronic injury that finally becomes too painful play through or affects his ability to move laterally that makes the surgery a smart course of action.

The surgery to repair the labrum in the hip is far more straightforward than the shoulder labrum repair, but make no mistake, this is still an injury that can end a player’s season, as it did for Devin Mesoraco in 2015. The Reds catcher attempted to avoid surgery and simply rehab the injury, but couldn’t get enough relief from his symptoms. So, after just 51 plate appearances, he chose to have the tear surgically repaired on June 29. This year, he made his spring training debut later than the rest of the Reds, first appearing on March 17, and was limited to just 17 at-bats, but was ready enough to start on Opening Day.

Now nearly eight months removed from the surgery itself, Mesoraco shouldn’t be showing any lingering effects. The first three weeks or so after surgery are set aside for recovery, but after that phase, rehab focuses on strengthening the surrounding muscles, specifically the glutes and core, and making sure the hamstring, adductors, IT band, etc. have good flexibility. These are all good things for a catcher to have even independent of a specific injury. This part of recovery is by far the longest phase, but even so, Mesoraco likely completed it in October, leaving him the vast majority of a regular offseason to get his normal work in. However, even if he’s completely past his hip issues at this point, keeping Mesoraco behind the plate could be a challenge.

Projecting 140 starts or more from any catcher, let alone one coming off a major injury, is a tough ask: In the last 30 seasons, there have been just 11 instances of a player playing 140 games or more with at least 75 percent of those appearances coming as a catcher. With Joey Votto a fixture at first base, there isn’t an obvious place to stash Mesoraco to keep his bat in the lineup without taxing his body, except to give him time as the DH during interleague play. If he remains healthy and the Reds find a way to get 140 games or more out of him, Mesoraco should be a major boon to an offense that scored the fifth fewest runs in baseball last year.

On the other end of the battery, Tim Lincecum had a more extensive version of the same surgery done in early September and, while he reportedly has been working out in Arizona, he’s a free agent and has not yet thrown a showcase for prospective teams. While he may not have been able to get into his normal offseason routine until the new year, Lincecum should be getting back to early season form soon, and the fact that no one has seen him pitch is not encouraging.

Assuming the successful completion of their rehab program, pitchers shouldn’t have noticeably worse outcomes after undergoing labral repair, though a pitcher with an extreme wind up—Hideo Nomo comes to mind—and a tear on his back leg would likely need additional time to get his full strength back. Lincecum’s repair was done on his landing leg, but his high lift, trunk tilt, and drive put an atypical amount of strain on the joint, which may help explain why he’s progressing a bit more cautiously.

The initial reports ominously described Lincecum’s injury as degenerative, which would complicate his recovery and, depending on how much damage to the joint had already occurred, limit the extent to which he would fully recover. However, after performing the operation, his surgeon, Marc Philippon, categorized the damage not as degenerative but as relatively normal wear-and-tear; he was also bullish on Lincecum’s ability to recover some of the velocity he has lost.

That promise, not only that he could come back from this procedure healthy, but also that he may have turned back the clock a bit, has to be intriguing to a number of teams. Indeed, per John Heyman, more than 20 of the league’s 30 teams are interested in attending his eventual showcase. Lincecum had been looking better in 2015, though he swooned before finally electing to have surgery, so there’s at least some reason for optimism, but two things should counterweigh that feeling.

First, while his results were objectively better in 2015 than they were in 2014, his peripherals weren’t showing the same improvement. That is, while he wasn’t giving up as many runs, he was still allowing baserunners at a similar rate, still striking out far fewer hitters than he used to, and actually allowing more hard contact than he did even in his execrable 2014 season. It’s unclear at this point exactly what a return to form would mean given how few comparable pitchers there are for Lincecum, but without missing more bats, allowing fewer runners, and inducing weaker contact, any improvement he shows is unlikely to last for more than a few starts.

Second, Lincecum isn’t a pure velocity pitcher, meaning that while recovering some of it would be good, it isn’t a silver bullet. He’d need to add five miles per hour to get back to the fastball velocity he had in 2011, his last truly effective season. Philippon is a fantastic surgeon, but he’s not Miracle Max; Lincecum isn’t a pitcher in his prime who happens to be coming off an injury; he’s now in the twilight of his career. That doesn’t preclude another handful of productive seasons if he’s healthy going forward, but it does mean that he’ll have to change his approach if he wants to have a graceful decline phase instead of the lead balloon drop he’s had over his last few years.

So 2011 Lincecum and his preceding glories are off the table, but would a team be interested in a version of Lincecum that reaches 2013’s velocities with a better sense of how to pitch without his early career arsenal? At that point, he’s probably a 2.0-2.5 WAR pitcher, and while teams absolutely start players far less valuable than that (looking at you, Kyle Kendrick), it’s one thing to have players like that stuck on your roster and quite another to purposely sign one.

Lincecum’s name alone will command an audience, so it’s unsurprising that the vast majority of teams plan to watch him throw. Additionally, if you assume someone will sign him even if your team doesn’t, it’s a first chance to do some opposition scouting on him, though one of the biggest questions ahead of his showcase is if he’ll get a chance to start or if he’ll need to take a year in the bullpen to show that he’s still capable of shutting down opposing hitters.

A Hardball Times Update
Goodbye for now.

If he can prove that he’s healthy and regained some of his velocity, even with the downsides mentioned previously, someone will roll the dice on him. The biggest caveat with Lincecum is not to make him a test case for pitchers returning from labral arthroscopy, since his particular delivery and pitch selection make him The Freak that he is.

Dan enjoys black tea, imperial IPAs, and any competition that can be loosely judged a sport. Follow him on Twitter.
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8 years ago

I’m a believer in Tim. Expect a bounceback, if some team finally ponys up the dough for him. http://twtwsports.blogspot.com/2016/02/take-chance-on-me-why-lincecum-and.html

8 years ago

Totally read the headline as “Liberal Tears” not “Labral Tears”

8 years ago
Reply to  anasazi

LTM… Liberal Tears Matter

Pirates Hurdles
8 years ago

Its pretty optimistic to suggest that Timmy is a 2-2.5 win pitcher now considering he hasn’t been that since 2011. He has been worth a total of 3.2 WAR in the last 4 years combined. Also, I think teams are quite happy signing 2.5 win SP and those they have are not really in the “stuck with” category.

Pirates Hurdles
8 years ago

Further, only 48 SP in MLB posted 2.5 WAR last year, we talking about #1 and 2 SP mostly with a few innings eaters sneaking in.

8 years ago

Recovering from this same surgery so will certainly be in his corner. I have found that the longer you went with it uncorrected (for me 8-10 years), the harder it is to course-correct the things you did to compensate (which I’m guess he had a lot of as an unorthodox pitcher).

Also rooting for Mesorroco and D. Span in this same regard.

8 years ago
Reply to  Dan Wade

the all labral tear team! Good luck on the rehab

7 years ago
Reply to  bill

Hey, I’ve just been diagnosed with FAI (likely in both hips) and came across this via Laurila’s recent interview with Lincecum. How are you guys doing with your recovery/rehab? Interested in hearing others’ stories as I contemplate my next move.

8 years ago

I wonder if he’ll find a new career trajectory — he wouldn’t be the first former starter who rejuvenated his post-surgery career in the bullpen, throwing max effort for just an inning or two. He has no significant platoon splits over his career, so might even be a candidate to be an extremely unorthodox closer.

8 years ago
Reply to  joser

Lincecum has already stated that his objective is to start again. Money has never been all that important other than getting what he thinks is fair. So there is ying and yang there. Has consistently said he would rather have shorter term deal than long term. Turned down $100M five year deal and ended up with two year deal then another two year.

So I think he will hold out for a chance to start, but have to think there has to be some limit of lack of competitiveness on the part of the offering team, I can’t imagine he would want to join rebuilding team. Has stated that he wouldn’t mind pitching for Seattle at some point. So it will be interesting how he chooses his next team.

James Filippi
8 years ago

Big Time Timmy Jim will be back in my opinion!

Connie B.
8 years ago

I have faith in Timmy. I think he will be back. I’m hoping with the Giants. I miss him. It wasn’t as much fun without him.

8 years ago

Farts are Freedom, my friend.

8 years ago

I agree with Connie.B
Giants baseball is better and more exciting with Tim (TLL). At least we have our 3 P’s right now (Posey,Pagan & Pence).
Having Timmy again would be great!
Not having The Freak to me is like not having Posey, not as great. Let’s just say that I go to games but I go to more games in hope of seeing Timmy.
Having Tim showcase and come back even to Seattle (would be sad) but would be great overall!
~Go GiANtS!~

8 years ago

In the end, the memories of Timmy The Freak Lincecum will still be with us Giants/baseball fans for a lifetime https://m.youtube.com/watch?v=3EghNaUH7Ro