New Boston Red Sox general manager Ben Cherington had his introductory (or re-introductory?) press conference overshadowed Tuesday afternoon by an announcement he made about 45 minutes into the event. In one of his first public acts as GM, he announced that beleaguered pitcher John Lackey would be going under the knife for Tommy John surgery.
My first thought was, “Isn’t that a bit…convenient?”
I do not have the ability to argue that Lackey does not need an ulnar collateral ligament reconstruction (UCL, the medical term for Tommy John surgery.) I am not a member of the medical community. But we have reached the point where it seems like every time a major league pitcher needs to take a “vacation” for a spell, they’re sent down to visit Dr. James Andrews (the nation’s best surgeon for this particular procedure) in Birmingham, Alabama.
This leads me to ask: Is the baseball community overprescribing Tommy John surgery?
Cherington admitted in his press conference (per the Boston Herald) that the arm soreness that kept Lackey out at the start of last season was related to the condition of his elbow in a contract signing exam in January 2010. When the soreness interfered with his pitching in April 2011, he was prescribed rest and placed on the disabled list. He returned, pitched and the soreness returned. Further examinations throughout the season monitored the injury, leading to Cherington to admit on Tuesday:
“Based on the combination of the symptoms, the physical exam of Dr. Yocum and the new MRI, Yocum felt like it was probably time to consider surgery.”
That progression suggests that the injury is a partial tear and not a full tear. There are a few ways you can treat a partial tear, via plain old rest and a few other procedures. Tommy John is not the default treatment – but it’s quickly becoming that way.
Tommy John was created to treat a full tear of that ligament, not a partial. But around 2000, about twenty years since the surgery was first performed, more partial tears began to be steered towards the procedure. If the procedure treated full tears so well, why not try it with a partial? The surgery now has a high rate of success (85% or better), so the invasiveness and lengthy rehab now seems worth the risk for either type of tear.
Two years post-surgery, a successfully rehabbed pitcher will report at least pre-injury strength, if not better. For a pitcher approaching their mid-30s, like Lackey, that increased strength may extend their playing career. Lackey is signed with the Sox until he’s roughly 36. If everything goes right with his rehab, that gives him that best-ever strength in the year his contract runs out.
The Red Sox may not like the idea of paying such an expensive pitcher for a year where he never dresses, but it’s not as dire of a situation as it could be for other ballclubs. The wealthier teams of Major League Baseball do not necessarily feel as devastating a blow to their organizations when a pitcher is lost for a season for such surgery, thus allowing them to steer athletes towards the procedure with much less trepidation. Says Dan Connolly of the Baltimore Sun:
“Interestingly, in Boston, Lackey’s situation may be viewed as a blessing in disguise. It may force the Red Sox to be even more aggressive for pitching in free agency this offseason because they can’t hope for a Lackey resurgence in 2012 – which may have been foolish anyway.
So they lose a $15 million pitcher for next year, and it may actually spur them into further action. That’s the advantage of the big-money teams.”
So the Red Sox can lose Lackey, but providing their new GM and owners are willing to spend, they’re able to weather the blow of not having him around.
Lackey also has some key personal issues to work through, and has not been the most favorite member of the Red Sox during his two year tenure with the team. Having him reframe his mindset for a year towards rehab and basics may be the kick in the behind the organization thinks could do him some good.
I am in no way saying that Lackey doesn’t need the surgery – he’s 33 and has been playing intense sports since high school (he played football and basketball in addition to baseball.) He’s been pitching professionally since 1999 – twelve years. If he didn’t have elbow problems after that much use, he would be a miracle.
But is the baseball community pushing too many pitchers towards this surgery? Was it Lackey’s only option for treatment? Or is it a convenient way to treat the problem and hide him away for a while? Are aging pitchers looking for a “quick” (more like higher percent of success) fix and hoping for a bionic arm at the end of the process?
And what happens if it doesn’t work?