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Saturday, September 18, 2010

The SPH 2010 Shoulder Surgery Survey (a.k.a. More Bad News For Mets Fans)

Due to my hectic summer, I haven't made an S.S.S. update for several months, but with one of the game's most prominent pitchers, Johan Santana, going under the knife, I thought it was probably an appropriate time to renew our discussion.  (To track how this all began, you can go here.)

I'm going to start with the good news.

The 2010 poster-child for shoulder rehabilitation has to be Ted Lilly.  Lilly was back on a major-league mound approximately seven months after having his "frayed labrum" repaired and before long he was again among the most dependent, durable, and underrated pitchers in the National League.  His record for 2010 is just 8-11, due in large part to playing on a pair of teams (Cubs & Dodgers) which seem to be coming apart at the seems.  Lilly's overall numbers are solid (3.83 ERA, 1.10 WHIP, 141 K, 172 IP) and very similar to what he posted immediately preceding the operation (3.10 ERA, 1.06 WHIP, 151 K, 177 IP).  Lilly may be showing a little fatigue.  He began his tenure with the Dodgers by winning his first five starts, but is 0-3 with a 7.47 ERA in his last four.  One could speculate that this is a result of a diminished strength-building routine following the surgery last offseason, but it could also merely be the result of natural tendency towards indifference bred of being a veteran on a team that no longer has a shot at the postseason.  This rough stretch aside, however, Lilly has done plenty to prove that the injury should not effect his bargaining position when he hits the free agent market this winter.

There have also been positive developments from Jeremy Bonderman.  Bonderman missed well over a year following his surgery, in part because he re-injured the shoulder trying to make too quick a return.   A note of caution to Santana and the Mets: Bonderman's injury was not unlike that which Johan recently suffered and, in general, there is a tendency toward re-injury following these surgeries.  Bonderman struggled getting back into sync following his long layoff, posting a 6.97 ERA in April, but has steadily improved over the course of the season.  Since May 1, he's 7-8 with a 4.75 ERA.  That's still a far cry from the pitcher who helped the Tigers get to the World Series a few years back, but there have been glimpses of that former glory.  Last week he shut down the White Sox for eight innings, allowing only three hits and striking out eight.  Perhaps this is a flash of what we can expect from a fully recovered Bonderman in 2011?  If not, he has still proven himself to be capable of being a back-of-the-rotation innings-eater.

Freddy Garcia played a similar role for the White Sox this season, his first full year since having his labrum repaired way back in 2007.  Garcia posted a strong record, 11-6, for the ChiSox, but with modest overall numbers (4.88 ERA, 1.43 WHIP, 83 K, 144 IP) before being shut down earlier this month due to an unrelated back injury.  It's apparent that, at 36, Garcia will never be the Ace he was earlier in his career, but he did manage sixteen quality starts (62%) in 2010.  You might be surprised to find that's more than All-Stars like Johnny Cueto, Yovani Gallardo, Andy Pettitte, and Phil Hughes.

Nagging injuries were a prevalent issue for our survey participants, perhaps no surprise considering the long period spent away from the game following their operations.  Not only could it effect their endurance, but also potentially their mechanics.  Reports out of Colorado this preseason suggested that Jeff Francis was having to completely relearn his delivery.  Francis continued to feel "tightness" in his pitching shoulder even after his return in mid-May, which forced him back to the D.L. after about half a season of work.  In his 17 starts he has been, much like Bonderman and Garcia, respectable but unspectacular (4-5, 4.61 ERA, 1.29 WHIP, 61 K, 96 IP).  He's mixed in a couple of gems (for instance, seven innings of three-hit ball against Florida in July), but also failed to get past the third inning on two occasions.  The Rockies are expecting him to take over Aaron Cook's spot in the rotation for the next two weeks.  We'll see whether he can rise to the occasion following a month of rest.

Sadly, considering how modest these results are, that's the end of the "good" news.  Of the eight players we began tracking at the beginning of the season, only these four managed to make it back to the mound in 2010.  The Mariners were cautiously optimistic that Erik Bedard would be ready by the All-Star Break, but he also fell victim to the urgency of his rehab and ended up having a "setback" which resulted in yet another surgery, this time to remove a bone spur.  As yet, there's still no timetable for his return.  The same can be said of Brandon Webb and Chien-Ming Wang, two other former All-Stars who may never fully recover from their injuries.  Webb is tentatively hoping to make a couple of relief appearances before the end of the season, but the D-Backs have been slow to confirm that report.  Having now missed almost two full seasons, it is impossible to predict what the former Cy Young winner will look like if he is indeed ready for Opening Day in 2011.  The future of Wang, the former Yankee Ace, is even more uncertain.  Same for Dustin McGowan, the promising young Blue Jays starter, who also had an additional surgery in June and is unlikely to be ready in time for Opening Day 2011.

All told, that's a pretty dismal picture of Johan's prospects.  Of these eight pitchers, seven of them missed a season or more rehabbing after surgery.  Of the four who have made it back to the mound, only one has come anywhere near his previous level of effectiveness.  While Santana isn't dealing with major labrum or rotator cuff repairs, the "torn capsule" is the same thing which Bonderman and Wang were treated for, and both missed well over a season.  It would be wise, based on this track record, if the Mets reconsidered their intentions of trying to have him ready in the first half of 2011.  That seems fairly far-fetched.  And, as we saw with several of these cases, the urgency to return can actually prolong and exacerbate the injury, even to the point to requiring additional surgery.  I would not expect Santana to be ready before August of next year.  Even then it is unlikely he will immediately pitch like an Ace.  Unfortunately, he may never again look like the perennial Cy Young candidate we've come to expect.


random commenter said...

I have to wonder if the extent of Webb's injury is truly what the Diamondbacks have reported. Every shoulder is different, and certainly any kind of shoulder surgery is serious business. but his was reported to be a debridement of the labrum. A cleanup. Yet the way his rehab has gone seems similar to that of someone who had undergone a repair.

Regarding Bedard's timetable, it was reported that he *should* be able to follow his normal offseason throwing program, putting him on track to be ready for spring training. This sounds a tad bit optimistic to me. but perhaps it is doable since his last surgery was relatively minor, and it didn't involve the original injury.

Hippeaux said...

That's an interesting point about Webb. The D-Backs did everything in their power to make the operation seem routine, but his rehab has been anything but.

As for Bedard, I'm pretty skeptical. His should has been troubling in some capacity or another for three seasons now. It's a shame. He's obviously an incredible talent when healthy, but he may be headed for a Mark Prior-like premature end to his career.

random commenter said...

I can see the parallels between Bedard and Prior, though the injuries have been different. But although it is quite troubling that Bedard's last three seasons have ended with surgical procedures, I wonder if it isn't unreasonable to think that he can make it back and be at the very least productive. He didn't seem to have lost much, if anything, following his labrum repair. In the three rehab starts he made this summer, his fastball clocked in its usual range (89-93) with good movement, and the curveball was reported to be sharp. And as the latest surgery revealed, the problem was confined to the spur on the AC joint, as the labrum had healed and the rotator cuff was fine.

Even the most minor of shoulder surgeries is serious, but seems like Bedard has a decent chance to recover from this one. The challenge is finding a way for him to remain healthy, which is the biggest of the uncertainties surrounding Bedard because given that he was never horrible while pitching hurt, and that he did relatively well during his rehab, it seems that even after three surgeries there is a good chance that he can still pitch well enough if he can remain injury-free. Maybe whichever team takes the chance signing him will have to strictly manage his innings in order to accomplish this.