192 replies to this topic

[Mackus]

Should've went ahead and had the surgery last February when it was first discovered. PRP and rehab was always a long-shot.

 

Nope.  Should the Yankees have just cut Cole, too?  Avoid this surgery as long as you can.  PRP success rate is relatively low, but its high enough that its worth the effort given the low cost of just a few months time and the extreme cost of the surgery.  Even with all the modern improvements, Tommy John is not a 100% recovery to previous levels (look at John Means for a recent example), so if you just slice guys open you're risking their entire careers rather than just a few months on the shelf trying to see if the UCL damage is manageable with the PRP.

[BSLChrisStoner]

I like where things are with him.
Nobody is counting on him being back this year, but he's in a realistic position to possibly contribute before the end of the year. Keep progressing.

[BaltBird 24]

Nope. Should the Yankees have just cut Cole, too? Avoid this surgery as long as you can. PRP success rate is relatively low, but its high enough that its worth the effort given the low cost of just a few months time and the extreme cost of the surgery. Even with all the modern improvements, Tommy John is not a 100% recovery to previous levels (look at John Means for a recent example), so if you just slice guys open you're risking their entire careers rather than just a few months on the shelf trying to see if the UCL damage is manageable with the PRP.

Cole didn't have a partially torn UCL. Looks like he had nerve inflammation and edema. Rest and rehab was able to correct his issue, he wasn't relying on PRP injections.

I know there's a small handful of guys who've been able to successfully come back with PRP injections, but I'd say overall success is very slim.

[BaltBird 24]

I don't know what constitutes a full TJS or the brace procedure, but maybe the brace will work on partially torn UCLs? Maybe that could've been an option last spring, also.

Edit - a quick Google search says the internal brace is a good option for partially torn, has a high success rate, and allows for immediate rehabilitation and mobilization.

Maybe I'd have went the brace route last spring instead of opting for full TJS.

[Mackus]

Cole didn't have a partially torn UCL. Looks like he had nerve inflammation and edema. Rest and rehab was able to correct his issue, he wasn't relying on PRP injections.

I know there's a small handful of guys who've been able to successfully come back with PRP injections, but I'd say overall success is very slim.

I recall posting a list of maybe ten or so guys who had elbow pain and did either PRP or rest & rehab and staved off UCL surgery for years and in some cases entirely. I'll accept whatever term you wanna cite for the success rate or non-surgical options, but I'm certain that success rate is worth the squeeze compared to the failure rate of Tommy John surgery when guys can't get back to prior levels.

[Mackus]

Maybe I'd have went the brace route last spring instead of opting for full TJS.

The surgeon decides if brace is an option once they are in there. As far as I'm aware it's not knowable based on scans. You can know for sure based on scans that there is a full tear. I think they did go into Bradish's surgery hoping they could only need to do a brace, but when they opened him up and saw the damage they decided they had to do full Tommy John.

Wells was a similar case but with a better outcome, he had brace.

[BSLSteveBirrer]

Nope.  Should the Yankees have just cut Cole, too?  Avoid this surgery as long as you can.  PRP success rate is relatively low, but its high enough that its worth the effort given the low cost of just a few months time and the extreme cost of the surgery.  Even with all the modern improvements, Tommy John is not a 100% recovery to previous levels (look at John Means for a recent example), so if you just slice guys open you're risking their entire careers rather than just a few months on the shelf trying to see if the UCL damage is manageable with the PRP.

I think much of this depends on just when that "few months of time" would be an impact. If a guy is hurt in say July then trying this and finding out it didn't work doesn't really impact playing down the road. He's going to miss the entire next year anyway if he has TJS now or two months from then. But same injury in February and the calculus is different. Could be the difference between pitching later in the next season or not.

[Mackus]

I think much of this depends on just when that "few months of time" would be an impact. If a guy is hurt in say July then trying this and finding out it didn't work doesn't really impact playing down the road. He's going to miss the entire next year anyway if he has TJS now or two months from then. But same injury in February and the calculus is different. Could be the difference between pitching later in the next season or not.

Ok, let's use games then...had Bradish had surgery last January he's probably back this year in June or July. Let's call it available for 80 games.

As it is, he was available for 40 games last season and possibly will return this season.

If he doesn't return at all, you're -40 games compared to earlier surgery.
If he returns in September for 30 games, then you're only 10 games in the hole.

Now consider that cost against the chance that the surgery doesn't go well and the guy never is the same. He might have a career still but hes not a top SP. Or he just can't get back at all, which admittedly is rare now but still happens (John Means). Is 10-40 games extra availability worth not finding out if a non-surgical option was plausible? Even if it's low odds of that non-surgical option working, I think the only people who will say yes are ones who overrate the survivability of this surgery.

[BaltBird 24]

I'd say the likelihood he'd eventually need surgery was still pretty high regardless of PRP and rehab. Sure, there's always the anomaly of those rare times it did work, but the odds were significantly against him. Go back to the thread where the news broke last spring and I'm sure the general sentiment was that surgery was inevitable.

The rehab did buy him 8 starts and 39.1 IP of brilliant baseball in 2024 at the cost of, potentially, the entire 2025 season.

[BSLMikeLowe]

When it comes to cutting a person open and swapping parts of their body I'm pretty much 100% in favor of that as the last resort.

[Mackus]

Go back to the thread where the news broke last spring and I'm sure the general sentiment was that surgery was inevitable.

 

Agree that was the general sentiment, but it was not a well-reasoned take.  It was a combination of doomsaying and people who don't actually understand the consequences of the surgery.

 

PRP and other non-surgical attempts are indeed low probability, but that doesn't make them unwise compared to accelerating a catastrophic surgery that may not be 100% necessary.

[BSLSteveBirrer]

Agree that was the general sentiment, but it was not a well-reasoned take.  It was a combination of doomsaying and people who don't actually understand the consequences of the surgery.

 

PRP and other non-surgical attempts are indeed low probability, but that doesn't make them unwise compared to accelerating a catastrophic surgery that may not be 100% necessary.

I get what you are saying but you are also overstating the risk of the surgical option too. TJS is never 100% necessary. Its never a catastrophic surgery.

 

A pitcher could just decide to hang up his cleats and not play baseball anymore.

A failed surgery doesn't preclude a pitcher from living a normal life. 

 

To really make a judgement on which way would be better we'd need more details.

1. What percentage of the non surgical attempts are successful? 

2. What percentage of the surgical attempts are successful?

3. What percentage of either approach end up requiring surgery or a second surgery?

 

Successful being defined as able to pitch again at the level of baseball (or above) that they were in when they got hurt.

[Mackus]

I get what you are saying but you are also overstating the risk of the surgical option too. TJS is never 100% necessary. Its never a catastrophic surgery.

A pitcher could just decide to hang up his cleats and not play baseball anymore.
A failed surgery doesn't preclude a pitcher from living a normal life.

To really make a judgement on which way would be better we'd need more details.
1. What percentage of the non surgical attempts are successful?
2. What percentage of the surgical attempts are successful?
3. What percentage of either approach end up requiring surgery or a second surgery?

Successful being defined as able to pitch again at the level of baseball (or above) that they were in when they got hurt.

It's absolutely a catastrophic surgery. I'm talking from a baseball perspective, not quality of life. It's the longest downtime of any common injury by quite a bit. It's the second most damning injury to a player's career among common injuries, severe shoulder damage is much worse but that's the only thing.

I don't have the stats you ask for handy, but agree they would help quantify the conversation more. I am very confident that the (admittedly low) percent of guys who can successfully rehabilitate a lower grade UCL injury without surgery more than justifies trying those methods when there is any hope of success.

I don't think the O's or Bradish made any bad choices in terms of his recovery. They made intelligent, pragmatic decisions. That was proven in that he was able to return at all. That the fix gave out not long after he returned doesn't negate the effort. Just like if Cole's elbow gives out this spring it won't mean they should've given him the surgery last year as soon as he had problems. I think most fans are both too fatalist about how any elbow pain always leads to Tommy John and too optimistic about how assured the recovery from Tommy John surgery is. It's not just the downtime, there is non-trivial risk that the pitcher just isn't as good anymore upon their return