Effectively Wild: A FanGraphs Baseball Podcast - Effectively Wild Episode 1267: The Ohtani Elbow Inquest

Episode Date: September 6, 2018

Ben Lindbergh, The Ringer’s Michael Baumann, and Tommy John surgery researcher Jon Roegele convene to discuss every aspect of the news that Shohei Ohtani will likely undergo Tommy John surgery, including how the Angels handled him and whether they bear any blame for the outcome, their recent rash of similar injuries and unusual treatments, Ohtani’s […]

🎵 The frustration it renders me painful by Jeff Sullivan because this is something of an impromptu podcast, emergency podcast that we have convened and Jeff is already on a trip. So today I am joined by my Ringer colleague, Michael Bauman. Hello, Michael. Hi. What has it been? 30 hours since we talked last? Yeah, roughly. Yeah, usually we go a week between conversations. We're talking on short rest. Yeah, but we had to have this talk now because we've already done our Ringer MLB show for the week and we just couldn't wait to continue this conversation. But we are also joined by John Roggele, who is a writer for Fangraphs and the Heartball Times and also a Tommy

John surgery researcher, which is why we have asked him to join us today. John, welcome. Thanks, Ben. Thanks, Michael. Nice to be here. Yeah, good to have you, except not great to have you under these circumstances. We are gathered here today to mourn the impending loss of Shohei Otani's ulnar collateral ligament. As we speak, he has not officially opted for Tommy John surgery, but it has been recommended to him and even the angels have recommended it to him. And so we are lashing out at the universe. We are looking for someone to blame. We need to direct our rage somewhere. So we just kind of want to talk about the implications of this and the road that took us up to this point and whether the angels are at all culpables for

how they have handled Otani or whether we should just blame the fragilities of human physiology and the cruel universe that comes for all young pitchers who throw hard. So we're going to talk about all the aspects of this, and Michael and I were just having a spirited debate, discussion. I don't know how to characterize it. By our standards, it was positively like throwing pots and pans. Yeah, we vaguely disagreed, which was unusual for us. So you have written about this situation for The Ringer, and your article will be up by the time most people are

listening to this podcast. But we wanted to continue our conversation here. And it's kind of strange circumstances because I was in mourning mode, And here's our man hitting homers at the same time that we are trying to mourn his elbow. I think it's important to point out that not only has there been no announcement as to Otani actually getting Tommy John, he's three for three with a home run and a stolen base as we're talking about this incredible roadblock to his career. So I don't know. Yeah, it's amazing. Yeah, it just highlights the uniqueness of Otani. With any other pitcher, when we get this sort of news, it's just all bad news. And meanwhile, he has hit a home run for the second straight day. And that is just, that's Otani for you. So we'll talk, I think, a little bit maybe about summing up his season

But we want to talk about how we got here And it seems like there's sort of a pattern in how the Angels have handled injured pitchers over the past couple years And they have had many injured pitchers to handle So we can establish a pattern here And I think it's not shocking to any of us that Shohei Otani is likely going to have Tommy John surgery. I think if you had told us that last December, when Jeff Passan first reported that he had what a first degree sprain of his UCL that was detected in November, once we heard that, and you know that it's just a young pitcher and he throws really

hard, you kind of get the heebie-jeebies and you think that this news is going to come eventually. But everything was going well for a while and he pitched great at the beginning of the season. And then there was elbow pain and then there was a layoff and then he returned from the layoff and now there is new UCL damage that was detected by the MRI. that was detected by the MRI. So, John, you've made a list of every pitcher you could find who has had Tommy John surgery in the professional ranks. Is it fair to say that the Angels do things a little bit differently when it comes to treating guys who have Tommy John surgery or may have to have it?

Because Michael and I were looking at your spreadsheet, which we will link to for anyone to consult, and they really do the PRP, the platelet replacement therapy, and they also do stem cell treatments. I think it's platelet-rich plasma. It's really hard to say. They do the stem cell thing too. And that's, as Michael was noting, there are plenty of pitchers who've had the PRP therapy, but there are not many pitchers who have also had stem cell treatment in conjunction with that. So they're kind of the outliers in of that from what I've been able to see. So of course, I don't have any inside information. So all of the lists that I'm able to accumulate is just from various media reports. So I'm sure there's a lot more PRP injecting going on around the league.

injecting going on around the league. But this is the list I've collected is purely of UCL injections specifically. And certainly of those, the Angels seem to be leading the pack as far as trying this. So we saw them try it with Andrew Heaney and Garrett Richards, of course, a couple of years ago, and Heaney's failed rather quickly. It didn't seem to make any difference for him. And he had Tommy John surgery a couple months later. With Garrett Richards, they had some more success. He obviously was able to return the following season, and he pitched for a while. But as we know, he also ended up with Tommy John surgery in July. So, you know, I'm not surprised that they went this way, given what we believe doctors told them. So that's all we really have to go on is that they told us that they, in June, when the new tear was discovered, they went to several

orthopedic surgeons, I'm sure it would have included Dr. Neil Elatrash, who seems to do most of their surgeries, because he's based in LA. And we were told that nobody mentioned the possibility of a UCL reconstruction at that time, given the damage that was there. So I'm not surprised that they went the way they did at the time. And as you said, I'm not surprised that it didn't work in the end. But you know, sometimes it does. I don't think we from what I've read, nobody really understands how or why PRP injections work. But from the ones I've tracked, you know, about half the time, players seem to be able to return to the same level of baseball they were playing at when they had the injury and the injection,

and at least to date haven't had to have had a Tommy John surgery. So, yeah, sometimes it works, and the Angels seem to be the team that tries it the most. And the source of the argument was that the Angels seem to be the team that tries it the most. And the source of the argument was that the Angels seem to be, and I don't know, I mean, four is not, because it's Otani Richards, Haney, and JC Ramirez, yeah, were the four pitchers that they use this on. And, you know, I certainly think that at this point in the season,

it was worth trying something, particularly considering that it's about a coin flip, whether the pitcher gets cut eventually or within a year or within a couple of seasons of getting the PRP. extended period of time be relatively durable without ever having to revisit the injury over the course of multiple years. And I think Otani's upside is so great that you sort of have to take that chance. I think where Ben and I came down on opposite sides of the issue was the Angels seem to be the only team that's doing this platelet-rich plasma plus stem cell injection. They've done it four times, and as of right now, it hasn't worked. And Richards is the only Richards is the only pitcher out of the four angels and the six pitchers overall who has thrown more than 10 big league innings before having to get Tommy John surgery. And my concern was that was not that Otani would blow out after two innings and change like he did. It's that he would pitch well through the end of the month and then get into spring training,

get into perhaps the first week or two of the regular season like Ramirez did, and then have to have Tommy John surgery. So in addition to missing most or all of 2019, he'd miss most or all of 2020 as well, assuming if he got to the back end of that 18-month recovery time frame. And so that struck me as a way to potentially make the – and this is – the way Billy Epler phrased it where they wanted him to pitch just to see – I forget exactly what his wording was, but his wording sounded kind of weird. They wanted him to pitch so if the ligament was going to blow out, it will blow out now.

And that's stress test sort of. Right, exactly. And I wonder, you know, some of the some of the success stories like Tanaka came back relatively quickly, but Nola had the entire offseason to recover from PRP. So did Garrett Richards, who only made one start when he came back, but went on the DL for five more months with an unrelated injury. And I wonder if that I don't know if that would have changed anything, because obviously these injuries are this. This therapy is so rare. It's only a few dozen cases. Stem cells are know that it's hard to to draw firm conclusions from it in terms of big league pitchers.

So I wonder if they would have been better off either resting him or, again, I don't know if the injury was severe enough for them to say, OK, let's go ahead with the get Tommy John out of the way now and make sure that we have him back as a hitter for 2019 and as a pitcher for 2020. For 2020, yeah. Yeah, I mean, I think that's a valid point i think it is hard to to know you know if it's gonna go when is it gonna go and so a physician presumably or a set of physicians you know gave him the go-ahead to be able to start throwing and so you know i imagine

that was exactly their thinking was let's see if we bring him back to have four or five starts this year. You know, if it blows, then we have time to do the surgery and, you know, not have to rush. He'll basically miss all of next year, but he'll definitely, you know, should definitely be ready for 2020. But you're right. I mean, it could have he could have lasted five starts and had the offseason and then it could have blown in April or you know maybe they could have waited till April to have him try but I guess if if he was cleared to throw now it must be their thinking because I think you know a lot of people think of the Tommy John return time as you know maybe 11 to 18 months or, or whatever. But I think when I look at major league level starting pitchers, which he clearly is, since 2014, after the rash of revision surgeries that were needed in sort of

2012, 2013 times, I'm framed since then, I've got like 24 major league pitchers who were starters at the time of their surgery and then returned as starters in major league baseball. And they are all 14 months plus, except for Jason Vargas, who's an older, softer tossing lefty. So not, you know, not quite the same. So pretty much everyone's 1415 months, the average is actually, I think about 18 months, because some guys took a couple of years. And of course, some of this depends on the timing of the surgery. But I think realistically, for somebody who's like Otani, who would, you know, you would definitely want as a starting pitcher to maximize his value, you'd be looking at at least 14 months. So if he has it now, I don't think there would be any reason for them to try to get him back next year.

Yeah, I want to return to that point in a moment. I have some breaking news, though, by the way. Since we started recording this podcast, Shohei Otani hit another home run. Oh, man. So if he just decides that he wants to be Barry Bonds and give up pitching, then he's going to be okay. Give it up. Yeah. Wow. Yeah. He really does not seem to want to go on the disabled list. He just wants to keep hitting homers. Yeah. he's controlling the news cycle today. Yeah, I guess he is. He's changing the narrative. So one thing I want to mention

is that just I have a hard time forming a hard opinion on anything here because there's just so much we don't know. I mean, we know the reporting, but we don't see the MRIs. Not that any of us would be able to read an MRI. People always say, oh, I haven't seen MRIs, not that any of us would be able to read an MRI. People always say, oh, I haven't seen the medicals, as if any of us would know what the medicals said if we had the medicals in front of us. But what we mean is we don't know what they say, and we don't know how they've been interpreted, and we don't necessarily know which doctors have seen them and what exactly they said. And we definitely don't know what Otani has said at various points in this process, which is also important because maybe he didn't want to have

surgery and you can't just force a player to have surgery. So if he was saying, yeah, give me the PRP, give me the stem cells. I don't want to go under the knife. Then that has to be part of the decision-making process. So that's a big part of it is just all the unknowns. And there's been plenty of reporting about, you know, what MRI said or didn't say. And the most recent reporting has said that before this new damage showed up, there was no damage or at least no damage worth worrying about or, you know, worse than the typical pitcher who has some degree of damage.

Like they didn't bring him back from this recent DL stint knowing that there was something that was about to blow, at least as far as the reporting. They weren't just saying, yeah, well, let's just throw him out there and we see some problems. But if it blows, it blows. Like according to what they saw, at least as it's been reported, he seemed okay, like he seemed good to go. And so he came back, and I don't know whether he hurt himself during the start the other day or what. I mean, we all saw his velocity tailed off dramatically in the third inning, and he said it was his back stiffening up and his hand getting hit by a comebacker, and clearly it probably was not just those things. But it doesn't seem like they brought him back thinking that there was still a lingering issue other than the fact that once you hear this about a pitcher, it's always kind of in the back of your head that this is going to happen.

So I don't know. I don't know whether at any point they recommended surgery as far as we know. Not until now. But we're not really privy to the conversations with everyone. And it seems like they weren't going against medical advice or doctor's orders as far as we know. They weren't like, like it would be a problem for me if they thought, well, let's do the stem cell stuff, even though no one really knows whether the stem cell stuff works. Let's just engage in some magical thinking and maybe that'll help and

we'll just push off the surgery that he'll have to have. Whereas other teams just wouldn't buy into the stem cell stuff and would say, let's just schedule the surgery right now. It doesn't sound like they think that way. I found a quote from Steve Yoon, the Angels team physician, who was trying to downplay people's expectations of what stem cell can and can't do, because it's just kind of unknown at this point. So to me, it just sounds like they figure, well, we'll try it because it probably can't hurt. And we don't know whether it will help. But if we're giving him the

PRP, we might as well just throw in the bonus stem cell treatments too, because who knows? Yeah, no, I think you made a number of good points there. And that's all we can go on is what we know, as you said, and it sounded like they did their due diligence and they took, you know, the MRIs around to a number of physicians. And Billy Epler said a few times, you know, nobody ever raised the possibility of UCL reconstruction. So they kind of went the stem cell way. And I think, as you said, comes down to really Otani in the end has to be the person who decides to have the surgery. I mean, we've seems to be getting a little more common now that teams announce Tommy John's surgery has been recommended for player X, you know, ahead of time and pressure on kind of and yeah, from from what I've seen, I have not seen any player, you know, once that's released a, no, I'm not going to opt for that, but really it's, it's his choice in the end. Right. There was a case just in the last couple of weeks of a player sounded like maybe somewhat similar scale on the, on the damage, but maybe,

maybe a little further along was uh in the tigers organization arty lewicki who has pitched at the major league level this this year and he basically opted it sounded like he had kind of was given a couple of options a conservative route and a surgery route and he you know said the best thing for me is just to get surgery over with and get it done and i think you know if it comes from the player that's great. He's, he's actually already been, been through it. He's the second one and he's, you know, talking to the same surgeon who did his first surgery. So he knows what he's in for and maybe in his situation that makes sense for him. But yeah, I think teams can't, they can maybe put a little bit of pressure, but they can't be

ultimately forced surgery onto one of their players, at least I hope not. Yeah. Yeah. It's University of Virginia College World Series hero, Artie Lewicki, Ben. Yes. Thanks. I needed to know that. Well, I think it's, I mean, it's fine that we don't know these things. Like there are laws that are protecting these players' privacy, and there's no reason why we should know all the intimate details of the state of their UCL at all times. So that's okay, but it just makes me hesitant to come down and say that Team X mishandled a certain situation.

It's possible. I think it bears extra scrutiny because you look at the Angels and their recent track record, and they've had a whole lot of pitcher arm injuries, and they've also had this unusual way of treating them that hasn't seemed to be very successful. So I think given that, it's fair to wonder whether they're doing something wrong here. I think given that, it's fair to wonder whether they're doing something wrong here. But when the news came out, the top Twitter replies on all the beat writer tweets were, well, he should have had this months ago. And I just – I can't come to that conclusion. I just feel like I don't know enough to say that.

And even knowing what I do know, I wouldn't say that. So that's kind of where I stand on all of this. And I think your reluctance to put your foot down on this, I think that more than anything else is where you and I disagreed earlier. Because I mean, I agree that we don't know the medicals and wouldn't know what to do with the MRI if we did see it. And that my contention was not that given the state of Otani's injury, that they did anything other than follow the team medical orthodoxy. But I think that there's a growing body of medical or of anecdotal evidence

that the Angels team medical orthodoxy with the stem cell treatment, and I don't know how that's supposed to interact with the platelets. I don't know if it does. I don't know what the potential dangers are, but just the word stem cells, you know, it feels advanced. And I wonder to some extent if it's just, you know, trying stuff, but this team medical orthodoxy of the, of the platelet, God damn it. PRP. The PRP in stem cells is unique in Major League Baseball. There's been four Angels pitchers who've done it and two pitchers throughout the rest of Major League Baseball or of affiliated baseball even who have done it.

And it hasn't worked. And we don't have enough data to draw any hard and fast conclusions obviously the angels wouldn't keep like it feels unlikely to me that they would have some sort of evidence that that this is hokum and then continue doing it but yeah it's interesting that that this treatment they they're the only ones who do this treatment the treatment keeps failing and you know epler said that they're going to continue like this doesn't change their their plan with the treatment going forward. And I don't you know, I certainly don't think based on their handling of Otani on one level, I would I would understand the inclination to just reach out there for a miracle cure

because the clock is ticking not just on Otani's contract, but crucially on Mike Trout. And he's such an exciting pitcher, and he brings so much positive attention to the team. You'd want him out there. But we've seen them really baby him throughout the course of the season, and it's very unlikely that they would act in a way that they thought was risky towards him. And I hate to be the guy who's just asking questions,

but I don't have any, I don't have enough evidence to do anything more than that. It just, it, it's a, it's a growing pattern. That's, that's what I would say. Yeah. And I don't know whether there really is any evidence out there that it works or that it does any harm. I just quickly Googling around, like it's clearly not a miracle cure, but it just doesn't seem like there's a whole lot of really good research yet on whether it actually works or not. And it doesn't sound like the angels are buying into some snake oil pitch that this is going to fix everyone, you know, overnight or something. I assume they're just kind of trying it because

might as well i can't it can't hurt i guess that's the thinking but yeah yeah i think that from what i've read that's sort of the current state of affairs at least with respect to uh the stem cells or sorry the prp i don't know a lot about what the stem cell edition does, but I think PRP is kind of known to be, PRP itself is known to be, or thought now to be safe anyway. It's not going to do any harm and it seems to help in certain cases and nobody can really explain why or how it's, how it's working. But I've read, you know, orthopedic surgeons who just kind of treat PRP like another favorite sauce or garnish. They just lather it in with any sort of surgery they're doing. It can't hurt and it sometimes helps. So they just throw it in. So yeah, I guess there's, you know, there's the question of are the angels

doing the right thing once a player is injured? And we've sort of talked about that. And then in the larger picture maybe with the angels just is there something they're not doing or doing incorrectly as far as right picture arm management because i see you know on twitter i see i think i've seen several fans from every single team lament their particular teams yeah definitely bad fortune as far as you know oh why do we have so many Tommy John surgeries and nobody else seems to but most of that is usually just noise but I think I remember looking at kind of clusters of of Tommy John surgeries on particular teams in particular years and I think

Mississippi State at the college level had oh now a year and Nebraska had a lot and I think the the Mets in a way affiliate I want to say Columbia had five within a few months but the Angels are this is now six if Otani assuming Otani has the surgery that would be six major league pitchers in a single calendar year which is I don't think there's ever been more than four ever on a major league team in one year. So, you know, and that doesn't include Tyler Skaggs and Andrew Heaney and Nick Tropeano and guys that are, you know, have had it in the last couple of years.

So pretty much all of their starting pitchers, even the guys they tried to bring in as, you know, patchwork replacements for their other injured starting pitchers even the guys they tried to bring in as you know patchwork replacements for their other injured starter pitchers have ended up needing the surgery or other major surgeries so if i was yeah if i was somehow involved in that organization i'd be a little concerned at what's happening yeah there would be a there's a timing element that I think, I mean, the the timing element of if he if Otani got through the end of this season and blew up in April, like I said, that's that's a huge risk. But they didn't they didn't do this, for instance, with Keenan Middleton when he went down. So this is I guess the the PRP and stem cells isn't

something they do literally every time, although looking at their injury list on Baseball Reference, they've got a lot of shoulder injuries, which is, I guess, I mean, that's the one injury you want to suffer less than a torn UCL. Yeah. But that's the other thing with the timing and why I don't really come down against the Angels here is that, as John was just saying, people think of Tommy John still, I think in many cases of a

one year thing that you get it and then a calendar year passes and then you come back like clockwork. And at this point that is rare, right? That is the exception sort of for it to happen that quickly. And I think teams have gotten more cautious about that and have realized that you don't want to rush the rehab process. And so if he had— And it's time—like, you, Darvish, missed essentially two seasons. Yeah. With Dario John. So if Otani had had the surgery in June when he first went on the DL with this, then he would still almost certainly miss all of 2019 and be back for 2020, at least as a pitcher.

And now we're a couple months beyond that, but it doesn't really change his timeline because he could still have, you know, an 18-month rehab process and be back as a pitcher for opening day 2020 if he had the surgery this month. So it doesn't really change anything. And we can talk in a second about his hitting and whether he can continue to be a hitter, but maybe it doesn't even change the hitting timeline that he could still be back as a hitter early next season. So I get it in that sense.

You might not be risking anything, really. You might not be risking any future playing time even. And I don't remember what the standings looked like exactly when he first came down with this. I have them in front of me actually, because I was curious myself, you know, and I agree with you. I think, you know, just knowing that they went to physicians and were told, you know, recommended this conservative treatment and presumably Ohtani did not ask to have surgery you know that on its own would mean to me that that's fine what they did but on June 7th which is the date that he had his PRP injection the Angels

had the fifth best record in the American League fourth best by base runs they were I guess because they were ahead of Cleveland they were three and a half games out of the wild card. But, you know, so, yeah, given the timing of that and the way the American League looked this year, you know, there's a lot of teams who were very clearly not going to be in the playoff picture already at that time. So the Angels were one of a handful of teams like we all expected before the season started who were fighting for that fifth spot. So they were still very much, there were seven games over 500, still very much, you know, should have had wildcard aspirations. Right. And by the time he came back, of course, they were out of it, but they had every reason not to want to shut him down for the rest of the

season at the time that this first popped up so there's that too and we should talk about the hitting aspect here obviously the way that the angels have handled him they have thought that hitting would not seriously exacerbate whatever was going on with his elbow that hitting doesn't place the same stress on your ucl that pitching does and clearly he is demonstrating that as we speak, hitting home runs since we started the podcast with this UCL that seems to require replacement from a pitching perspective. So, John, what do we know about the position player timeline to recovery?

How much faster does it tend to be? Well, it's definitely faster, but it's again, it's not totally a given that it's going to be quick. There still can be setbacks. We see, I guess, a good recent example is TJ Rivera in the Mets system has, you know, everyone thought he would be back by, you know, A or June and he's going gonna end up missing the whole season but it tends to be more like you know 10 months 11 months and that's for a position player who is a defender right so right you know presumably it could be quicker i know there was and michael can help me because he'll probably remember it's one of the clements sons that this is the problem when they you name them all the same name it's either Cody

or Casey Clements whichever one has had whichever one had Tommy John surgery while at Texas and I think he came he was an infielder but he came back I remember yeah both of them and DH okay yeah he came back as a DH you know earlier than he would have been able to otherwise. And then I think the following season, you know, returned to infield duty. So, you know, because Sotani could DH theoretically, you know, the timeline might be quicker than someone who may have to make some throws as part of his defensive duties. So, you know, I would definitely think he'd be back you know barring some sort of setback he could be back for most of next year anyway if not basically the whole thing and it sounds like billy epler said they still view him as a two-way player of course they might

say that anyway just because he wants to be a two-way player and they'd want to appease him but they are at least as far as we know, still planning to have him be one as soon as he physically can be. But it seems like there's no reason not to have him hit next year as he comes back as a pitcher. And that's the other thing that I think people treat it almost as an automatic now that if you have Tommy John, you will come back. You'll miss some time, but you'll be back and you'll be as good as ever.

But that's not the case, right? I mean, what are we looking at as the success rate now? Is it hovering somewhere around 80% generally with major league guys? Because that's kind of my understanding, but I haven't looked at the numbers recently. Yeah, I think that's, I mean, if I look at, yeah, major leaguers as a whole, it is about 80%. You're right. As far as returning for, you know, a single game after the surgery at the major league level, I think we could probably drill down a little more and look at if we looked at players who were had a skill level closer to otani's i'm sure the return rate is is higher because the last the last guy i remember having tommy john and and he came back eventually but ryan madsen missed several seasons yeah because he didn't come back i don't't, I'm, I'm probably missing somebody, but I don't remember a really high profile guy like that missing like three or four years or not coming

back at all since then. Yeah. Yeah. There's Johnny Venters, I guess, former podcast guest who had to have so many surgeries. Had to have so many. Yeah. He was an elite pitcher, but he's also had about 14 Tom Johnsers. Right. Well, it's a possible outcome. You can need to have a revision and have to do it all over again. You can break your elbow on the mound like Dan Winkler did. Oh, yeah.

That's awful. That is. Yeah. Thanks for bringing that up. Yeah. I mean, yeah, I think someone at his skill level, you know, the 80% is going to include some people who were, you know, sort of just barely made the major leagues as a fringe, you know, replacement level pitcher and then had surgery. And then, you know, maybe they don't quite get back to the same level. And, you know, a couple of years older, they just, yeah, that's just hard to get back. But, you know, but I guess there are pitchers, not major league, but somebody like Tyler Kolek in the Marlins system

was a very high draft pick, threw really hard, and he had Tommy John surgery, you know, in April of 2016, it looks like. And he's, you know, he was at A-ball at that time, and he still hasn't made it back you know to abel two and a half years later so he wasn't that good before tommy john okay no maybe yeah i mean he's i'm just looking at his numbers and his post yeah i don't know what his numbers are definitely worse but he was struggling uh in the low minors right after the draft yeah by the way john what's the larger trend league-wide?

Because it seemed like a few years ago we maybe talked about the Tommy John surgery epidemic more than we do now, and I know there was like a year or two maybe where there was a bit of a decrease as far as I recall, and it still happens often, but there's, I guess, a little less hand-wringing now than there was maybe a couple of years ago. But maybe that's just because we've gotten used to it. We're just resigned to the fate.

Yeah, I bet it's – and not to interrupt, but I bet it's partly we've just gotten used to it. But also there was that rash of Darvish and Matt Harvey and Jose Fernandez all at it like right in a row. And it just felt like it was never – like every time you loved a young pitcher, he was going to get Tommy John. Yeah. So what's the trend? Yeah. It's sort of started to come back down. So I think kind of 2012 through 2014, there were quite a few, even 2015, quite a few. So, and you know, as I mentioned before, there were a number of revisions. So that's when, even 2015, quite a few. So and, you know, as I mentioned before, there were a number of

revisions. So that's when, you know, a lot of guys were having their second surgeries. And I think that's what probably caused teams to ease off a little bit on the rehab timelines of their of their starting pitchers, at least. But yeah, there's been pretty much 20 Tommy John surgeries at the major league level a season. And this is the third year running pretty much 19, 20, 20. And there were, yeah, kind of 25 to 30 in many of those other years. So it's slowed down some, but there's still, you know, in general, especially outside major league baseball, there's still still a lot of these surgeries happening and see more and more people drafted every year who have already had the surgery in high school or college and certain organizations

in particular don't seem to mind drafting people who have already had it. So it's still around. I think it's slightly lower than it was a few years ago, but still certainly pretty common. Well, I wanted to ask both of you guys this, which is a conversation that Jeff and I had just last week, I guess, when Otani was coming back, but season in review, and now, well, I don't know whether Otani will keep playing the rest of this month because he wants to keep hitting homers and getting experience as a hitter, or whether he will just shut it down and go out on a high note here with this multi-homer game. But his season is winding down, maybe done at this point.

How do we grade it? How do we assess it? Given all of the hype and the excitement, was Shohei Otani's season a success or a disappointment or qualified success? How would you two both classify it? Michael, what do you think? I think qualified success because I think part of the question around him was whether or not his two-way skills would translate from NPB. And I, even in less than 300 plate appearances and 50 innings, I think he's proven beyond a shadow of a doubt that he's a very good big league hitter and pitcher.

And I think so much of the battle was that. Just coming here, making the leap, bringing the attention to the game and to the Angels specifically and playing both ways effectively. And he's honestly, he's a better hitter than I expected him to be. And over the course of a full season, I think he'd be about where my reasonable best expectations were as a pitcher. But that said, like, if he was supposed to come over here, I know you and I talked to Bill on the Ringer MLB show in April or early May about what Otani would have to do in order to be an MVP candidate. Like what what a two way season would would look like that would get him into into the territory where you're talking about him and Trout is sort of co-best player in baseball.

co-best player in baseball and obviously that never materialized because so much of of the the battle for a messiah younger mvp candidate is just staying healthy you know playing every day and i like there's a reason that the war is a count is a cumulative stat so from the perspective that he didn't come over here and sneak into the MVP discussion and become the pippin to Trouts Jordan and lead the Angels back to the playoffs like that all didn't happen but I think the he answered a lot of the big questions and now it's just we've got a two-way player in Major League Baseball when he comes back and pitches presumably in 2020 unless given tonight's performance, he just shrugs all this off and decides to throw 200 innings next year on a shredded UCL. And that's part of the cool thing about him is like, even after watching him for most of his season, I still don't really have a good idea of what his limits are.

I don't think that he's finished improving as a player. I don't think he's shown what he has capacity to do over a full season. If he ever gets to the level where he plays enough to get 500 plate appearances and make 30 starts. So I think he's proved that he's good and maintained the, I don't want to say mystery, but like the, the ability to inspire awe and really

get people to dream on him so i from that perspective i think he's been successful but obviously it could have gone better yeah what do you think john i don't know what your level of hype was coming into the season my level yeah i mean yeah it's true it's the only thing i've ever seen you get excited about. Yeah, no, I mean, I was certainly excited, excited as well to see what he could do. And I mean, I think largely I agree with what Michael said. If I had to give a different answer, I would say that not just a qualified success, but perhaps an unqualified success that he, you know, did everything that Michael talked about and sort of really

the only thing that held him back was was injury and you know we all knew before he got here that he had some UCL damage and we know what tends to happen to pitchers who have UCL damage eventually and so you know you could say that he you know did everything he could to the to the best of his ability and you know what he showed on that while he was on the field and healthy enough was pretty spectacular and you know a lot of pitchers get injured especially angels pitchers it seems so you know if you decide to not fault him for the injury, then I would say success is an unqualified success, perhaps. Yeah, I mean, he showed that he could do everything except be invulnerable. Basically, he could hit, he could run, he could pitch, he could not stay healthy.

But no one seems to be able to do that, at least reliably or predictably. But I'm looking at the real-time leaderboards on Fangraphs right now. Minimum 250 plate appearances this year. That's 288 hitters. And Shohei Otani is tied for seventh best with a 157 WRC+. That is including his two homers tonight. I mean, 157, he's a top 10 hitter in baseball. And I know that is less than half a season's worth of plate appearances, but nothing about

the underlying performance makes you think it's some sort of fluke or that he's locking out. He clearly has great power and pretty good plate discipline and contact ability. Like he's just a good hitter and coming into this year. I mean, I was pretty optimistic just because I felt like he'd been the best hitter in Japan when he was healthy. And that's a high level league. And I thought that if he could be the best hitter there at such a young age, then he could be a capable hitter, at least here. And there were scouts, you know, saying that he couldn't be, that he wouldn't be able to be a big league hitter or even an average hitter or better than an average hitter at least here and there were scouts you know saying that he couldn't be that he wouldn't be able to be a big league hitter or even an average hitter or better than an average hitter

and he's been a star level hitter and really also a star level pitcher I would say at least at his best and not coping with blisters and injuries and I think he was getting better at pitching he was improving the way that he approached hitters and so yeah I hope that we get to see the full season because I wrote an article early this year when he had that one week when he was worth one win above replacement just in a week because he had two great starts and also hit a few homers and that was like the demonstration of everything we had hoped to see and you know he's not ever going to do that on a full season on a weekly basis but i really hope that we do get at least a season at some point of that of just the reins off no leash just show he ohtani set him loose and see what he can do and you know he is only 24 years

old and a young 24 so he'll be hitting at age 24 next year hopefully he'll be back and pitching at age 25 the year after that and I still really hope that we get to see the the full operational Shohei Otani the two-way experience over a full season. I guess the problem here, one disappointing part of this is that- And I'd hope for more than one- Oh, yeah. You're talking about Otani the way Sixers fans used to talk about Joel Embiid. Well, yeah. No, I hope we see it for 10 years. Joel Embiid's a basketball player. Yeah, that I know. I didn't fully understand the rest of the reference, but that much I know. Yeah, that I know. I didn't fully understand the rest of the reference, but that much I know.

But yeah, I mean, look, I hope we see it for a decade or more, but people didn't think we'd see it at all. People were skeptical that a team would even let him try. That's another thing. No one thought he would necessarily even get the chance to do this, or there was considerable skepticism about that. And a team did, and a team is still saying it will when he gets back, at least for now. So I hope though, you know, the other problem here is that if he'd had a healthy season this year, I mean, he was on, you know, a very prudent and cautious, not that it necessarily helped, but he was being handled carefully and he wasn't hitting on the days after he pitched and he was pitching once a week. And I was kind of hoping that if he got through this season healthy, then next year they would just set him loose and he'd be, you know, a full time player on both sides or at least close to it.

And the problem is now that if he comes back in 2020, then he won't have pitched a full season. There's going to be an age limit. Right. I mean, he's only pitched. I have to click onto the pitching tab of his page now to see his innings pitch because I'm on his hitting tab, which is something you only have to do with Shogo Tani. Yeah, 51 and two-thirds innings pitched. And he barely pitched last year in Japan because he had an ankle thing that kept him out for a while. last year in Japan because he had, what, an ankle thing that kept him out for a while.

So now you're talking, and not that he was ever a workhorse really there anyway, and it's a shorter season there. So his innings pitched high in Japan is 160 or so, and that was back in 2015. In 2016, he was at 140. So he's going to come back in 2020, let's hope, coming off 25 and a third innings in 2017, 51 and two-thirds innings in 2018, zero innings in 2019. So it's not like we're going to see 200 innings Shohei Otani in 2020 either. So it's almost like you have to wait till 2021 to hopefully see him really unleashed which is kind of a bummer but i hope that day comes one thing i'm i'm interested to see and i i don't expect either you to to be able to make predictions about this but how if he comes back and hits for any significant chunk of the season how that affects his rehab because i mean there's got to be mean, part of the reason that they,

they're only DHing him this year and not playing him in the outfield or they're not having him hit the day after he pitches is there, you know, there's fatigue element to playing and a scheduling element. Like rehabbing from an injury is a full-time job, and so is playing Major League Baseball. So I'm interested to see, and, you know, maybe this is a is the thing where you know he goes and rehabs his elbow in the morning and then goes plays at night and and just never really feels the any ill effects from it but i'm interested to see if there's any interaction because we know how position players come back

from this kind of injury we know how pitchers do but it's he's only got the one body, even though he fills two roles. Yeah. Yeah, John, you'll have to start a new tab on your spreadsheet for two-way player Tommy John rehabs. Yeah, that's right. See what the typical recovery time is. No kidding. Although I say that, I wonder if there's got to be

at least some college precedent for this. Well, that's what I was thinking. There's got to be college, or certainly high school, but probably college as well. I mean, it's maybe a different no no schedule tommy john cases i could think of like cal quantrill were two-way players rodan's injuries weren't to his elbow mckay never had tommy john so i don't know what the if there's a college certainly a major college precedent because they'd be one of the places where they'd have the resources to put him on a big league type recovery program. But that's something to look into. I was just looking at Luke and Baker's baseball cube page, who's the closest thing to Otani we've seen at the college level.

But he had a muscle strain as a freshman and has not returned to the mound since. And it looks like the Cardinals haven't put him back on the mound, which was just disappointing. If you're listening out there and you happen to know an example of this and see how these things interacted, please let me know. Yeah, I don't know. That will be interesting to see, and I just hope. I mean, if he comes back next year,

and we don't know exactly when he'll be able to come back because, again, there's not really much precedent for this sort of thing, but if he's able to come back toward the start of the season because he'll be DHing, and I don't know, maybe he would play a position later in the year. I think Epler said he'd have to get medical clearance to do that because he'd have to be making throws, but even he gets like a full dh season and if he's as good a hitter in that season as he's been in this partial season i just i hope that they stick with the two-way plan because it would be so easy to say this guy is a superstar hitter so why even you think it would be easy to shut off to keep him off the mound well not to convince him to

no like i don't i don't think you could sell that i don't think you could convince baseball ops or a manager to keep him off the mound after he's shown what he's shown i don't know i mean coming into this year so many people thought well they're not going to risk him if they think he's an ace pitcher yeah but that's when they thought he'd suck yeah right exactly yeah and now we know he's good at both. Well, yeah, and you would assume now, I mean, even if he re-injures his UCL, he can apparently hit multiple home runs

with said injured elbow, so he could finish the season, have another surgery, you know, late September, and be back for most of the next year as a DH again. He could just be like a Mothman every other year. He'll just be a hitter one year, and then he'll have Tommy John,

and then he'll just pitch for a year, blow out his elbow, hit the next year, could just alternate. Yeah, but if he's like a combination of James Loney and, well, Artie Lewicki, I guess, then it's easy to to move them off one or the other. But you can't you can't shut off one end of this now. I hope not. Yeah, I really hope I hope not, too. Yeah. All right. Well, I don't know if this has helped you all come to terms with this. I mean, I feel better. I feel better.

And also I feel like I was emotionally preparing for this for the last six months or so. So I've I've had time to. That doesn't mean it's going to happen. I've been emotionally preparing for the Noah Syndergaard Tommy John for three years now. Yeah, I know. Yeah, it does seem that way. I've been spared that so far. Well, all right.

Any other trends or research that you've done, John, that is relevant here that you want to plug that people may not know about Tommy John surgery or have we covered it all? I don't know. I think we've covered sort of the relevant details to Otani anyway. And I try to maintain this database. So I update it daily. I spend a few minutes looking for them anyway. And anytime I see any, I update it. So you have a Google alert set up. I hope Tommyy john do you get notified i don't but i search enough that i find i think i find yeah enough anyway so uh yeah and i've just kept it public so everybody can go and look at it for whatever reason writing an article or doing some research or just interested to to see who's had the surgery or some various stats and metrics around it. It's all there anyway, so you can find it online. What do we know, by the way, you have a tab on your

spreadsheet that only has nine names on it right now, but one of them is a former Ringer MLB show guest, right? Seth Manis. You and I talked to him, Michael, about his internal brace surgery that is kind of a recent innovation that the hope was that it would significantly shorten recovery times. But I don't know whether we have enough of a sample to say that that might work or that, I mean, only certain guys are candidates for it anyway, right? So we don't know that Otani could even benefit from that. That's right. Yeah, I think it tends to be younger players. So it's, yeah, a certain type of damage, I think, is, you know, make somebody a candidate. And I think there's only a few doctors that probably perform this, but it was, yeah, developed by Dr. Jeffrey Duga. And he apparently did a number of surgeries on, you know, high school and I think some college players in there. Yeah, he had very good

success rates on the candidates that he selected that he thought would be good, good candidates for that type of procedure. So yeah, I mean, as you said, I only have nine names, because it's not very well publicized. And, you know, people often confuse the two or just refer to this as Tommy John. And it's sometimes hard to kind of go digging to see exactly what kind of surgery it was. But yeah, there's really not a whole lot of data here. There was a player in the oakland organization who who tried the internal brace who about a year later ended up having the full tommy john surgery but there's yeah there's a few people who have who have done it and come back some triple a players and yeah mitch harris and seth manessa a lot of cardinals if if the angels are the leaders of the uh the stem cell I think the Cardinals are

seem to be the the organization that's most willing to try this they've tried it with four players that I know of out of the nine or out of the eight I guess an affiliated ball so yeah I guess it's it's something that uh would be great because it does theoretically cut down the recovery time somewhat, but I think it's still pretty early from as far as public data to make any determination as to how successful it is or how much it actually cuts off the recovery time. All right. Well, I guess we can wrap up there. Maybe the takeaway is that the number one object of our ire here is evolution for not preparing pitchers' elbows better for throwing 100 miles per hour repeatedly off a mound. So it is our physiology that is failing us here probably more than any particular team. And we will just have to wait to see Tuwe Otani again.

I thank you both for coming on and helping me cope with this. I thank also William Zastadio for hitting a home run tonight too, just to give me another bright spot to think about instead of Otani's UCL. And if you have any thoughts that you want to share, feel free to email. It can just be group therapy, a little support group for fans of Two-Way Otani. We will get through this together, and hopefully he will too. So, Michael, thank you, and

John, thank you. Thanks for having me on. Thanks, Ben. Alright, you can support the podcast on Patreon by going to patreon.com slash effectivelywild. The following five listeners have already done so. James M. Gannon, Michael Adler, Evan Cleave, Zachary Levine, and Frederick Hines.

Thanks to all of you. You can join our Facebook group, comment in one of the Otani coping threads at facebook.com slash group slash effectivelywild. You can rate and review and subscribe to Effectively Wild on iTunes and other podcast platforms. Your ratings and reviews, we are given to understand, do help the podcast. And you can keep your questions and comments coming for me and Jeff via email at podcast

at vangraphs.com or via the Patreon messaging system if you are a supporter. Thanks to Dylan Higgins for his editing assistance. As mentioned, Jeff is traveling and out of town, and this is our third episode of the week, so that will do it for this week as well. So this is earlier than we usually say this, but have a wonderful weekend, and we will be back to talk to you early next week. I said now I'll take it, it's better for you.

Somehow we'll make it, cause that's what we do. Something out there we'll love is your only friend. And we are the ones that will make you feel better. Someone to spare when love is the only end. And we are the ones that will make you feel better.