Kyle Trimble is a licensed physical therapist here to provide MLB injury analysis. Read his 2021 MLB Tommy John surgery update as part of The Game Day’s MLB Preseason Injury Watch.
2021 MLB Tommy John Surgery Updates: MLB Preseason Injury Watch
A costly and lengthy rehab, UCL reconstruction/repair — otherwise known as Tommy John surgery — has allowed many pitchers to come back and continue their careers to varying degrees of success. A number of pitchers last season underwent Tommy John surgery, costing them significant portions of their season or in some cases, the entire upcoming season.
Anatomy of the elbow’s UCL
The ulnar collateral ligament (UCL) in the elbow is a ligament that runs on the inside portion of the elbow that provides stability between the ulna and humerus.
During the throwing motion with acceleration, the elbow takes a significant level of stress to throw the ball accurately and at speeds above 90 mph. Due to factors such as overworking, acute injury, or poor biomechanics, this ligament can fail, leading to pain and instability within the elbow, preventing effective throwing. The anterior bundle is most important for elbow stability.
Rendered image of the ulnar collateral ligament in an elbow (Credit: TwinsDaily.com)
Outcomes
While the recovery time is roughly 12 months, they can take even longer, upwards of 18 months. In a study from 2014, full recovery takes on average of 20 months. When they do come back, their career lasts roughly 4 years longer until they retire. In addition, the revision rate for this procedure is just under 4%. However, their production does increase with a lower percentage of losses, walks, hits and ERA, among other statistics.
However, in a study from 2016, the recovery timeline is the same as above, but revision rates are reported at 13.2%. As a result, those with a revision surgery have even shorter remaining careers with 2.5 years compared to 5 years after primary UCL repair.
The reason this timeline takes so long is due to the fact that a portion of a tendon is taken from elsewhere in the body and relocated to the elbow. A tendon attaches muscle to bone and with it transplanted to the elbow to act as a ligament, it must adapt to connecting bone to bone. There are newer procedures that use internal bracing to help reinforces and repair the damaged ligament, cutting down on rehab time.
The tissue must not only heal in the new area, but it must adapt to the demands of the joint during throwing. It must also be slowly loaded to meet the rigors of pitching. Throwing is a relatively unnatural motion at those speeds which is why pitchers are in this position in the first place.
Below is a notable list of pitchers that had surgery in 2020 with their surgery dates and expected timeline to return.
2021 MLB Tommy John Watch List
MLB Betting & Fantasy Baseball Outlook
Jordan Hicks, St. Louis Cardinals
- Surgery: June 26, 2019
- Return: Early 2021 season (COVID opt-out in 2020)
Hicks took 2020 off and could re-enter the Cardinals’ closer picture at some point this coming season.
The Cardinals should be a solid contender for at least the NL Central crown in 2021. They’re barely the favorite at (+175) on BetMGM. Having Hicks around to stabilize the back end of the bullpen would help.
Jameson Taillon, New York Yankees
- Surgery: August 14, 2019
- Return: March 2021
The Yankees took a chance on the high-risk, high-reward righty who looks ready for the start of the MLB season. The former Pirate will be relied upon to hold a spot in the rotation for the majority of the year as New York looks to extract some stability out of a risky SP group behind ace Gerrit Cole.
New York is at (-175) to win the American League East, the clear AL Winner favorite (+250), and the second-strongest World Series favorite at (+600).
Tyler Beede, San Francisco Giants
- Surgery: March 20, 2020
- Return: May 2021
The Giants’ first-round pick (14 overall) from the 2014 MLB Entry Draft was finally showing signs of elite upside late in 2019 and into the start of last season, but his required surgery put a stop to any progress.
Don’t expect the Giants to be in the running for a postseason spot.
New York Mets starting pitcher Noah Syndergaard (34) is one of several starting pitchers returning from Tommy John surgery in 2021. (USA TODAY Sports)
Noah Syndergaard, New York Mets
- Surgery: March 27, 2020
- Return: Early Summer 2021
Thor added another layer of risk to his tantalizing but often disappointing profile. He may not reach his peak this season but might show flashes that could help as he hits free agency before the 2022 season.
The Mets are expected to compete strongly for the National League East (+170), the National League pennant (+600), and as the sixth-strongest favorite (+1200) for the World Series crown. Getting Syndergaard back for the stretch run — perhaps merely as a reliever for some time — would bolster their already strong rotation.
Chris Sale, Boston Red Sox
- Surgery: March 30, 2020
- Return: June/July 2021 (best case)
Sale didn’t get a chance to prove that his 4.40 ERA from 2019 was a fluke, missing all of this past season. The 31-year-old may need another year before recapturing his past elite form.
Expect Boston to fall short of the playoffs in 2021 while Sale rehabs.
Luis Severino, New York Yankees
- Surgery: February 27, 2020
- Return: July 2021
Sevy also had a bone chip removed from his elbow during his procedure. New York may treat him with kid gloves at first, but his presence would provide much-needed rotation depth.
Yonny Chirinos, Tampa Bay Rays
- Surgery: August 25, 2020
- Return: 2022
Chirinos could be a nice buy-low for fantasy baseball dynasty formats as Tampa Bay works without him.
Justin Verlander, Houston Astros
- Surgery: September 30, 2020
- Return: 2022
Verlander should be good to go for 2022, which would start over 18 months from the surgery date. The righty will turn 39 years old before the 2022 campaign starts.
His absence has highly influenced the longer-than-usual odds for the AL West division win (+150), AL pennant (+1100), and World Series title (+2200).
Mike Clevinger, San Diego Padres
- Surgery: November 17, 2020
- Return: 2022 season
This was an investment for the future by the Fathers, and the righty with the herky-jerky delivery will be 31 for his next regular-season action.
San Diego has enough depth in its 2021 rotation (Yu Darvish, Blake Snell, Dinelson Lamet, Chris Paddack, Joe Musgrove) to weather Clev’s absence. The Pads are the fourth-strongest World Series champion favorite (+900).
Of the pitchers above that have required Tommy John surgery, this is the second instance for Jameson Taillon and Mike Clevinger. This will raise a lot of questions about whether the newly traded Taillon will be effective for the Yankees this year and Clevinger for Padres when he returns in 2022.
Research has also shown that following the procedure, overall pitching velocity decreases by 0.7 mph regardless of age and fastball velocity decreases by 2.5 mph in individuals over age 35. Curveballs, change-ups and slider velocity did not change following surgery. In addition, innings pitched and WAR decreased regardless of age.
While Justin Verlander will not return this season, he is the most worrisome of the group above. However, all the pitchers above are at risk for decreased velocity, forcing them to use their other pitches to get the job done.
It is not known whether the pitchers above had a repair or reconstruction, but there is not enough research to support that the repair is the preferred method until further studies are performed.
Each pitcher slated to return in 2021 must be carefully watched. While the names above are significant and teams have invested a lot of resources into them, it still doesn’t ensure that they will be as efficient as prior to the surgery. Successful pitchers may have to adapt to pitching with technique rather than power.
When these pitchers come up in the rotation, be wary about placing big money on the game or inserting them into your fantasy rotation until it’s established they have the run support and defense to help them. Look at how the pitcher has won prior to the injury and that may indicate how they pitch upon returning.
I would be concerned about those that pitch with power having greater difficulty in controlling the game. While the surgical techniques and rehab have drastically improved, performance and longevity are still questionable for each individual player.
Don’t draft too aggressively in your fantasy baseball leagues when it comes to the pitchers scheduled to return in the second half of the season. Delays in the pitchers’ recovery time may render the initial timetable moot, and most players don’t get their full control and command back until at least 18 months following surgery.
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Kyle Trimble is a licensed physical therapist who also works as an injury spotter for Dr. David Chao. Kyle has extensive experience in outpatient orthopedics, skilled nursing, acute care hospital and home care. He’s also a member of Bills Mafia and runs the website Banged Up Bills.
Disclaimer from Kyle: My opinions are my own. Any thoughts I have on the injuries are based on media reports, my knowledge of the injury and speculation based on the information currently available including video and print media. This information is subject to change based on the information released by the team.
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