If Shohei Ohtani joins the two-time Tommy John Surgery club, here’s what he could expect (2023)

When Shohei Ohtani fired a fastball and winced Wednesday afternoon at Angel Stadium, a victorious visiting clubhouse 700 miles away at Comerica Park in Detroit went silent. Sitting at his locker and watching the TV, Cubs starter Jameson Taillon knew that look. “Something’s not right,” he said. As Ohtani exited early, a few Cubs teammates wondered aloud whether the Angels would just shut down Ohtani for the season. Taillon worried it was worse than that.

Confirmation came a few hours later, when Taillon checked his phone and saw the news that Ohtani had torn his ulnar collateral ligament (UCL). It’s not yet known if Ohtani’s injury will require surgery. If it does, he’ll be the next member of a club that recently has reluctantly welcomed Jacob deGrom, Shane McClanahan and Dustin May: two-time Tommy John guys.

“When a player as big as Ohtani goes down, everyone is concerned,” Taillon said Thursday. “It spreads like wildfire throughout the league. Everyone is talking.”

One of Taillon’s first texts went to Daniel Hudson, his former teammate and fellow Tommy John revision recipient. When Taillon underwent his second Tommy John surgery in August 2019, there were three pitchers he looked to for motivation, guys who already had made their way back onto the mound after a revision surgery: Nathan Eovaldi, Tyler Chatwood and Hudson. There weren’t many other options. Four years later, the list is significantly longer.

Baseball analyst Jon Roegele’s ever-expanding list of MLB players’ Tommy John surgeries, from No. 1 (Tommy John himself in 1974) to No. 2,344 (McClanahan on Monday), includes a tab for players with multiple Tommy Johns. That tab has now grown to 148 names that run the gamut from Peter Moylan to Pete Fairbanks, from Jack DeGroat to Jacob deGrom, from Brandon Bailey to Brandon Beachy.

“It sucks that the quote-unquote club is getting a little bit bigger,” Hudson said, “but there’s definitely a pretty good lane to coming back and being an effective starter after the second (surgery). In Shohei’s case, we’re all hoping for the best. We all want and need him out there for seven or eight innings every fifth day.

“The guy’s a unicorn. Everybody says it in the locker room: he’s on a different planet. To see him hurt and potentially having one of his aspects of his game taken away from him for a while, it’s just a complete bummer. He’s so good for the game. We need him out there.”

There is no perfect match for Ohtani’s situation. He is capable of things no other player in baseball history can do, like blowing out his elbow again and still hitting every day for the rest of the season, as he intends to do for the next month. He is, in that way, in a club of one.

The timeline for Ohtani’s right elbow repair depends on the severity of the UCL tear and on the course of treatment he chooses — from PRP injection to internal brace augmentation to complete Tommy John revision.

There is scant literature covering the success rate of Tommy John revisions. A 2016 study found that 42.3 percent of pitchers returned to pitch at least 10 MLB games after the revision. Another study in 2020 reported that 50 percent returned to a previous competition level for at least one year. Stronger data should be available in the coming years as more pitchers undergo revisions.

“With the way technology has advanced over the years, we have a pretty good procedure that has a pretty high return-to-sport rate, you’re talking 80 to 90 percent return-to-play (rate) after (the first) Tommy John,” said Eric Bowman, an orthopedic surgeon who is the head team physician for Triple-A Nashville and Vanderbilt baseball. “With revisions, it’s just not quite as predictable.”

One reason for that, Bowman continued, is that the procedure is more complex the second time. Depending on which techniques were used for the initial surgery, the surgeon may have to work around remnants from the previous procedure such as scar tissue, hardware and drill tunnels in the bone. “Sometimes you have to negotiate that to get the exact reconstruction you want,” Bowman said. More recently, surgeons have opted to add an internal brace to supplement the revision, acting as a backstop to relieve some of the stress on the repaired ligament.

A revision generally carries a longer recovery than the original Tommy John surgery, but that hinges on the exact procedure performed and, in this case, on whether Ohtani elects to return as a two-way player or just a hitter.

The best sign that Ohtani would recover well from a Tommy John revision, should it be necessary, could be how well he recovered and performed after the first surgery.

“What’s positive for him is he got back to a high level of playing,” said Chris Ahmad, the Yankees team physician who has also performed Tommy John surgeries, “but the other factors, I don’t have that information, and that is: What is the tear pattern like? Where is the location of the tear pattern? Are there any other associated injuries? Is his ulnar nerve, for example, OK? Is his flexor tendon injured as part of it? And does he have any bone spurs or other procedures that would also have to be managed along with the Tommy John itself?”

For now, those questions remain unanswered.

Pitchers who have gone through multiple Tommy John rehabs said that if Ohtani has surgery and can continue to hit while his elbow heals, hitting could be a refuge for him. The toughest part of a second lengthy rehab, they said, is staying in a healthy headspace when the thing you’re best at is taken from you. The second rehab, Hudson said, was “the exact same as the first one, which is what makes it harder.” Same procedure. Same rehab. Same slow progression to throwing, just longer. But, once again, Ohtani has options none of them did.

“He’s young, he’s very talented, and he has a maturity about him,” said former All-Star closer Trevor Rosenthal. “If I had to bet money on him playing for the next 10 to 15 years, I would put money on it.”

Rosenthal is in the club now, too. He had his first Tommy John surgery in August 2017, a year before he reached free agency. He was devastated, counting the tens of millions he’d just lost, and worried he’d never pitch again. He did, though other injuries have prevented him from fully returning to form. When Rosenthal’s UCL tore a second time this April during an appearance for Triple-A Toledo, he physically felt the same — same pop in his elbow on a pitch, same pain and decreased velocity the next time he tried throwing — but the nerves had subsided, for a few reasons. He’d gotten paid well. He was more confident this time the surgery would work. He knew what to expect in the rehab process. And, not for nothing, he happens to know a number of pitchers now who have undergone multiple Tommy Johns and made it back to the majors.

“You look for guys who have done it so you can say, if they did it, I can do it,” Rosenthal said. “It’s surprising how many guys have had success going through it a second time. … I look around and now we have Jacob deGrom and maybe Shohei Ohtani, and I’m like, OK, at least I have a little bit of company with me. I don’t feel like I’m on an island.”

Buehler, the Dodgers starter on target to return from his second Tommy John next month, said earlier this summer that seeing Taillon sign a $68 million free-agent deal and Eovaldi “throwing as good as anybody in baseball” was good news he held onto as he rehabbed.

“It can be done,” Buehler said.

Tommy John surgery is an epidemic.

Surgical repair has advanced in such a way that return to competition is almost a guarantee.

But as an athlete, it can be an incredibly tough time.

It feels like getting the rug yanked out from under you.

A poor timed injury can cost the… pic.twitter.com/6CkVKRzSlV

— Trevor Rosenthal (@TrevRosenthal) August 24, 2023

Ohtani’s injury got Rosenthal, like so many of his baseball brethren, thinking about the existential crisis of Tommy John surgeries these days. “An epidemic,” he called it.

“If you’re an elbow, you’re not in a good spot being on a pitcher’s body, unfortunately,” Reds reliever Tejay Antone said Thursday, two years to the day he tore his UCL the second time. He moved on, talking about the flexor acting as the first line of defense for the ligament —taking the brunt of the force until it tires — when he stopped suddenly and said, “Dang.”

He had just pulled up Ohtani’s last pitch on his phone.

“That’s just so sad,” Antone said. “Looks just like how I felt. Gosh.”

“Man, what a loss for baseball,” Moylan added.

Brian Anderson, now a Rays color analyst, pitched 13 seasons in the majors before he confided in Royals teammate Mike Sweeney in the third inning May 8, 2005, that his elbow was barking. Sweeney alerted manager Tony Peña. Anderson never pitched in the majors again. He had Tommy John surgery, pushed through red flags to return to the mound in 10 months, and blew out again the next spring. (The second surgery was scheduled for July 21, the same date of his first. Anderson bumped it back a week. Bad vibes.) The surgery damaged Anderson’s ulnar nerve. He’s still numb from his elbow to his mid-forearm, and in his ring and pinky fingers.

Back then, with two Tommy Johns, Anderson was an outlier. Not anymore.

“Everything is max effort, full bore,” Anderson said. “It’s no wonder guys are going to continue to go down. They talk about managing workload and limiting innings. It doesn’t matter. If you’re going that full-out all the time, you can limit a guy’s innings all you want (but) he’s a ticking time bomb.”

This trend, the way the game has moved toward power pitchers and punchouts, was on Hudson’s mind after he learned the Ohtani news late Wednesday night. “Guys are going to do whatever they can to out-stuff the next guy,” he said. The problem, down to the youth game, is easy to identify. But even the guy whose story was at the center of “The Arm,” Jeff Passan’s book about Tommy John surgery, isn’t sure how exactly to save the next generation of elbows.

Hudson had his Tommy John surgeries less than a year apart, in July 2012 and August 2013. He went 26 months between pitches in the majors. Since then, he has lived a good baseball life, transitioning from starter to reliever and logging 420 appearances with the new elbow. The night Hudson threw the final pitch of the 2019 World Series, Taillon was sitting in the right-field seats at Minute Maid Park in Houston. He was two months post-op after his Tommy John, still babying his elbow, and marveling at what he’d just seen Hudson do.

“Being there in person, it felt like a core memory,” Taillon said.

Hudson has pitched just 27 innings for the Dodgers since the start of the 2022 season. He rehabbed a torn ligament in his left knee for 13 months, then sprained a ligament in his right knee in his third outing this season. He has hinted recently that his knee troubles could mean the end of his baseball career. It’s frustrating, he said, but there’s this: “At least it’s not my arm.”

— The Athletic’s C. Trent Rosecrans, Evan Drellich and Cody Stavenhagen contributed to this report.

(Top photo of Trevor Rosenthal, Daniel Hudson and Jameson Taillon: Ron Leiter, Scott Grau and Christian Peterson / Icon Sportswire, MLB Photos, Getty Images)