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.

SPH 2010 Shoulder Surgery Survey (March)

About a month ago I outlined my intentions to follow the trials and tribulations of eight starting pitchers attempting to return from shoulder surgeries in 2010.  We have gotten off to an auspicious start.  When Spring Training began, at least six of our eight participants were aiming to make the Opening Day roster.  Now, with the regular season about two weeks away, that number is falling fast.

Brandon Webb, the most notable pitcher in the group, complained in early March that he felt "stagnant." Unable to build upon his early progress, he has resigned himself to opening the season on the D.L. and is aiming for a late April return, at the earliest.

Chien-Ming Wang, another former Ace, trying to make a comeback with the Nationals, threw his first bullpen session on Wednesday.  While reports were very positive regarding Wang's control and the movement on his sinker, two concerns following his disastrous '09 season, the timetable for his return has been tentatively set for early May.  With Stephen Strasburg headed to the minors and Wang joining Ross Detwiler and Jordan Zimmerman on the D.L., the Nats are forced to audition guys like Garrett Mock and J. D. Martin for the rotation.

Ted Lilly, whose surgery this offseason was supposed to be "routine," suffered a couple early setbacks and has yet to appear in a preseason game.  He threw off the mound for the first time this week and is optimistic he could be ready by the middle of April.  The Cubs don't need a fifth starter until April 19th.

Dustin McGowan made a Spring Training start on Friday, but as he surgery was more invasive than Lilly's his rehabilitation process is dramatically longer.  Since Toronto is in rebuilding mode and have a number of starting pitchers who they'd like to have a long look at in 2010, they will not rush McGowan, who is certainly one of the most talented in the group.  He was capable of throwing in the high 90s prior to the injury, but hadn't thrown a pitch for about eighteen months.  He will build up his arm strength during an extended Spring Training, likely followed by a long rehab assignment working his way up through the Jays minor-league system.  If all goes well, I'd bet on a June return to Toronto.

Erik Bedard, who the Mariners re-signed with the full knowledge that he was unlikely to return prior to June, has been cleared to throw his first bullpen session this week.  Seattle GM, Jack Zduriencik, even speculates that Bedard may be a little ahead of schedule.  However, I wouldn't put much stock in any diagnosis when Bedard has yet to throw off a mound.  The Marines signed him hoping to get half a season.  Hopefully, they'll stick with that timetable for his return.

While most of our roster won't make an active roster this April, there is some good news as well.

The Tigers' Jeremy Bonderman has made four Spring Training appearances and is likely to make the Opening Day rotation.  His overall numbers are skewed by a very rough outing in early March, but in his last two outing he's thrown a total of six innings, allowing eight hits and three earned runs, while walking two and striking out four.  Bonderman is struggling to regain his control after missing most of the last two season, which is to be expected, but he's throwing the ball in the mid-nineties, an encouraging sign that he will could eventually regain the velocity he featured prior to surgery.  The Tigers rotation hasn't been set, but Bonderman would probably make his first start against Cleveland in the Tigers first home series, April 9th through 11th.

Jeff Francis of the Rockies is also on schedule for an early April return.  He's thrown nine innings so far this spring and is one schedule to throw 85-95 pitches in his first regular season start, which will likely be the Rockies home opener against San Diego on April 9th.

Finally, Freddy Garcia is on track to make his first start on the 11th against Minnesota.  Garcia was able to make nine starts at the end of 2009 and is now more than two year removed from his surgery, so the White Sox haven't been treating the veteran with any kid gloves this spring, never questioning that he would be their #5 starter.

With the possible exception of Garcia, who the White Sox believe will be capable of pitching deep into games, as he did during his tenure with them from 2004 to 2006, most of these pitchers will be on strick pitch counts during the opening months.  For Francis and Lilly, who have always made their livings pitching to contact, that shouldn't be a terrible problem.  For Bonderman and McGowan, that could be a major adjustment, as both are strikeout artists who tend towards high pitch counts even when they are throwing well.  

The Sporting Hippeaux's 2010 Shoulder Surgery Survey

I've recently been participating in some preseason roundtables over at Inside Pulse Sports.  Our discussion of the Arizona Diamondbacks, specifically Brandon Webb, prompted a little debate about the effectivity of shoulder surgeries.  The conversations got me thinking, 2010 is going to be an important season for surgeons.  Webb is just one of several notable pitchers who are returning to work after a major reconstructive surgery cost them the better part of the 2009 season.

In recent years, even the casual baseball fan has become familiar with "Tommy John surgery," the elbow operation which hundreds of major-leaguers have undergone.  The procedure has become so effective that are even cases of pitchers increasing their velocity upon returning.  Tim Hudson, Jake Westbrook, and Shaun Marcum are among the Tommy John recoverers who should be ready at the beginning of 2010.

Major shoulder injuries, on the other hand, are viewed as the death knell for pitchers.  Randy Johnson's discovery that his rotator cuff was going to require surgery may well have been what prompted his decision to retire.  Mark Prior had a shoulder replacement in 2007 and still hasn't made his way back to a big-league mound.  Mark Mulder has been trying to make his way back from a 2007 operation, but has managed only a dozen innings (and not good ones, either).  Shoulder injuries which required surgery also cut short the relatively promising careers of Matt Clement and Kris Benson.  The list is goes on.

There have, however, been a few instances of full recovery.  Pedro Martinez had to have his rotator cuff repaired in 2007 and while he struggled in 2008, his return to the mound last season with the Phillies was very successful.  Chris Carpenter had his labrum repaired in 2002 and has since been one of the best pitchers in all of baseball, winning a Cy Young in 2005.  Al Leiter had both Tommy John and shoulder surgery in 1989, at the age of 23, and proceeded to have an excellent career.  This experience helps lend a little credence to Leiter's prediction, as an MLB Network analyst, that Webb would be able to make a full recovery because he relies mainly on a sinker and has never needed an overpowering fastball (Leiter had a similar arsenal).    

A 2008 study of orthopedic surgeons found that only about a third of professional players were able to achieve their pre-injury level of production following a major shoulder surgery.  More than a third not only were unable to regain their former glory, but were forced into retirement.  Elbow surgeries faired much better, with slightly more than half of the players returning to full strength or even improving.  Sadly, it was still true that 30-40% of players were permanently effected to an extent that they were unable to continue to play.  More recent surveys have the specific ulnar collateral ligament reconstruction, known as "Tommy John," succeeding at a much higher rate, perhaps as high as 80-90%, though not every player gets a full recovery and the rehabilitation and strengthening process can be very lengthy.

Two years is a long time in terms of 21st-Century medical technology, so perhaps it's time for another look.  Eight noteworthy pitchers with be returning from shoulder operations early in 2010.  Throughout the season I'll be closely monitoring their progress and providing updates and analysis in hopes of understanding a little more about the long-term effects of this difficult and unpredictable procedure.

Here's our roster:

Zduriencik Makes a Midseason Move...in February

The Seattle Mariners have already been the toast of the 2009-2010 offseason.  Perhaps no two trades have been more unanimously lauded than GM Jack Zduriencik's acquisitions of Cliff Lee from Philadelphia (for three minor leaguers, none of which were big-name prospects) and Milton Bradley from the Cubs (for 250 pounds of eminently releasable pitcher, known as Carlos Silva).  Zduriencik also made a big splash by signing one of this year's most desirable free agents, Chone Figgins, to a four-year deal.

Those moves, all involving noteworthy players and all accomplished before Christmas, already had many anticipating Seattle making a serious run at the AL West crown.  It should be noted, however, that Zduriencik has not been resting on his laurels in the last six weeks, and it may be his recent thrifty additions to the Mariners depth chart which make the eventual difference in what seems sure to be a hard-fought race with both the Angels and Rangers.

In the last month, Zduriencik has made a flurry of interesting speculative signings, many of which seem designed to increase the potential options at the positions which remain somewhat in flux, namely first base, left field, and designated hitter.  Granted, the Mariners may have been fine sticking with Bradley, Ken Griffey Jr., and two of their top prospects, Michael Saunders and Mike Carp, but with the injury history of the two veterans and, of course, the general inconsistency of rookies, it seems wise to have a Plan B.  Zduriencik has given his manager, Don Wakamatsu, plans C and D as well.

Look out for falling prices...

When I previewed free agency in mid-November there were 83 featured players.  As of this morning, 48 of them had either signed, accepted arbitration, or retired, including all of the players who I expected to dictate the market: Holliday, Bay, Lackey, Chapman, Figgins, and Valverde.  At this point, with the beginning of Spring Training only a month away, those who remained unsigned are starting to get anxious.  Many teams have already declared themselves "spent" this offseason.  So, with demand shrinking, we are also looking at an inevitable drop in prices, particularly at those positions which still feature a fair supply of options.  During the waning months of the last offseason, several players signed cheap, short contracts and proceeded to produce well above their pay grade, including Adam Dunn, Bobby Abreu, and Orlando Hudson.  If you believe, as Eric Karabell says, that "there is no such thing as a risky one-year deal," than this is a great time for general managers to play with the house's money.

Orlando Hudson & Orlando Cabrera

This is the second time the Orlandos have found themselves in this unsavory position in the last twelve months.  Last winter both players signed one-year deals for under $4 Million.  Frankly, I don't understand it.  Both players are Gold Glove-winning middle infielders who are solid, sometimes superlative, offensive catalysts, and are also widely recognized as good teammates and energizing clubhouse presences.

Hudson is suffering in part because of his mysterious benching by Joe Torre late in last season.  Torre elected to turn to Ron Belliard (who's also still available) more and more in September and October, even though Hudson was an '09 All-Star and really only had one poor month (June).  In fact, his OPS+ (109) was the highest of his career.  Nevertheless, though O-Dog very well may have had legitimate beef with Torre's decision, he never voiced any displeasure and he embraced his newfound role, even coming up with a pinch-hit homer in Game 5 of the NLCS.

Cabrera's season had a slightly different arch, as he slumped with Oakland through the first four months of the season, but when he came to the Twins, he immediately became a favored member of the club, lauded by fans and management, who inspired his teammates and came up with several big hits (none bigger than the homer he hit in Game 163 against Detroit).

To me, these seem like players who you want on your club, but for the second year in a row the bulk of general managers have disagreed.

Potential Suitors (for Hudson): Cubs, Twins, Tigers, Nationals
Potential Suitors (for Cabrera): Astros, Reds, Twins

Miguel Tejada

The former AL MVP has the opposite problem from Hudson and Cabrera, whose perceived weaknesses are clearly as hitters.  Tejada proved in '09 that he is still a force to be reckoned with at the plate, by leading the NL in doubles and batting .313.  Even though he's a free swinger (only 19 BB in '09), there are very few teams that would welcome his addition to their lineup.  The problem is that many believe that Tejada's defensive skills have eroded to the point that he is no longer a satisfactory option at the game's premier defensive position, shortstop.  As such, Tejada's marketability in the coming months depends largely on his willingness to make a switch, probably to third base or designated hitter.  If he can swallow his pride and commit to such a conversion, just as Michael Young did prior to last season, he will see a dramatic increase in suitors and a corresponding increase in salary.

Potential Suitors: White Sox, Angels, Twins, Athletics

Erik Bedard & Ben Sheets

One of the new business of baseball catchphrases is "reestablish his market."  It refers to players who need to take a short-term contract, not only because current demand necessitates it, but because it will be better for them in the long run.  Assuming they prove their health and effectiveness, Bedard and Sheets could be in line for much, much larger paydays a year from now.  Both have the potential to be frontline starters.  Sheets is a four-time All-Star (he started the game for the NL as recently as 2008) who is still in his early thirties.  Bedard is also just 31-years-old and looked on his way to becoming an Ace before injuries limited him to only thirty starts in two seasons with Seattle.  Even so, in those thirty starts, Bedard went 11-7 with a 3.24 ERA, a 1.26 WHIP, and 162 K in 164 IP, which gives you a sense of what he might've been capable of if he was fully healthy.

This is where Karabell's maxim really comes under fire.  If your teams signs one of these pitchers, you expect them to produce, at the very least, like a #2 (just ask those Cubs fans who assumed Rich Harden would be a Cy Young contender in '09 after he looked so dominant during the second half of '08).  Unfortunately, the odds are that at least one of these guys not only will fail to fulfill that expectation, but will probably miss most of the season, potentially crushing a whole city's dreams in the process.

Potential Suitors: Cubs, Dodgers, Rangers, Cardinals, Brewers

2007 Kisses and Curses - Part 1

One is tempted to wax poetic about the expectation with which every season begins. Players from the Diamondbacks to the Devil Rays pronounce, assuredly, their intentions for October. For some, undoubtedly, it is just another in the long string of cliches which comprise their dialogue with the media throughout the season. For many, however, these enthusiastic predictions are sincere, often among the only sincere statements they prove capable of. Similarly, as fans, and fantasy-junkies especially, we begin each season with pronouncements and predictions. Sleepers and keepers; steals and busts and locks; overrated and underrated; can't-miss prospects and falling stars. If we have the guts, around this time of year, in mid-August, we must size ourselves up. Sometimes we resemble the White Sox, the Giants, and the Athletics. All that spring training effusion was just so much hot air. Other times we are like Detroit, Cleveland, and Anaheim, right where we expected to be. And then, on those rare occasions, as with the Diamondbacks and the Mariners, there we are, but we're not exactly sure how it happened. This edition of The Sporting Hippeaux isn't about teams, it's about players. We've got those that have lived up to - no - exceeded our expectations: the Kisses. And those that have failed them: the Curses. We all know, regardless of spring platitudes, every year is a little of both.

Ryan Braun - 3B - Milwaukee Brewers (Kiss)

Ironically, since recalling the mighty Braun from Triple A on May 25, the Brewers are 29-39. That is, after starting the season 31-15. Nonetheless, Braun is not only the best rookie of 2007, he has been arguably the best hitter in the league ever since he joined it. Check this out. These are stats for some of the MVP front-runners since May 25:

Alex Rodriguez (991 OPS, .292 AVG, 18 HR, 63 R, 66 RBI, 9 SB)
Magglio Ordonez (897 OPS, .344 AVG, 6 HR, 42 R, 49 RBI, 2 SB)
Vladimir Guerrero (908 OPS, .325 AVG, 8 HR, 39 R, 52 RBI, 1 SB)

Prince Fielder (1009 OPS, .287 AVG, 20 HR, 47 R, 50 RBI, 0 SB)
Miguel Cabrera (1091 OPS, .350 AVG, 20 HR, 41 R, 49 RBI, 0 SB)
Ryan Howard (1070 OPS, .296 AVG, 26 HR, 52 R, 70 RBI, 0 SB)

Ryan Braun (1060 OPS, .349 AVG, 21 HR, 53 R, 55 RBI, 10 SB)

Besides telling you that the rumors of Miggy's weight problems and Ryan Howard's regression might have been a bit exaggerated, the numbers suggest that Braun was, like Pujols and Ichiro before him, an MVP candidate from the moment he stepped on the field.

Alex Gordon - 3B - Kansas City Royals (Curse)

It was not Braun, but Gordon, who got all the rookie hype going into the 2007 season. He was coming off a stellar performance at the 2006 Futures Game and, unlike Braun, he was given a starting role on opening day. Unfortunately, Gordon has followed in the footsteps of many preseason rookie-of-the-year favorites. Of the thirteen rookies with 250 plate appearances, he is 11th in AVG and OPS, 12th in SLG, 7th in HR, and 8th in RBI, despite having the 4th most at-bats. Despairing fantasy owners should remember in this case especially, this year's curse is next year's kiss.

Eric Byrnes - OF - Arizona Diamondbacks (Kiss)

...and vice versa. It's almost impossible not to root for Eric Byrnes. He shamelessly flirts with Fox anchor, Jeanne Zelasko, and employs the word "Dude" in every potential grammatical situation. And this season, for the first time, he is outplaying nearly every outfielder in the National League. He shouldn't have been reporting from McCovey Cove during the all-star game, he should've been starting in center field. But beware. Byrnes is the prototypical sell-high player. He's never shown skills like this before, he's over thirty, and despite his big contract, he's going to have lots of competition for playing time in the Arizona outfield in the next couple seasons. I hope he, like Gary Matthews Jr., is just a late-bloomer. His personality certainly suggests as much. Don't go putting $30 Million on it. Oops.

Nick Swisher - OF - Oakland Athletics (Curse)

In my 12-team Salary Cap Keeper league draft this April, Nick Swisher was the #1 pick. Spurred no doubt by accounts of his down-on-the-farm winter workout and his 35 HR/95 RBI performance in '06, this owner drafted Swisher ahead of guys like Dice-K, Prince Fielder, Sheffield, Helton, Francoeur, Sheets, and Robinson Cano. To be fair, had he fallen to me, I would've picked him ahead of all but Prince, Sheff, and Cano. When the season began it looked like a fair choice. In April and May Swisher accumulated 9 HR and 32 RBI, with a respectable average. Unfortunately, he has added only 5 HR and 23 RBI in the interceding months, while hovering around the Mendoza line. The one promising sign is that Swisher has cut back on his strikeouts (a discouraging 152 in '06), while continuing to improve his plate discipline. His OBP remains outstanding (.392) even during his power shortage. Many critics will suggest that the much-heralded Swisher has settled into the league as Adam Dunn Lite, but next year he will be 27, that magical number for baseball players, and there is still a fair amount to get excited about.

Erik Bedard - SP - Baltimore Orioles (Kiss)

Bedard is striking out hitters at an obscene rate. At this pace he will easily surpass the 250 K plateau, which hasn't been done since 2004, and could reach Big Unit-levels (he's currently on pace for about 275). During his current 8-game winning streak he has 80 K in 60 IP, with a 2.24 ERA and a .167 Batting Average Against. Whether it is the tutelage of Leo Mazzone or thet magic 27, Bedard has officially arrived as one of the few true Aces in the major leagues, alongside guys like Santana, Halladay, Zambrano, and Oswalt.

Dontrelle Willis - SP - Florida Marlins (Curse)

Of course, pitchers are more susceptible to chance and whimsy than any other set of players. The list of supposed aces who've had catastrophic seasons in '07 includes Cris Carpenter, Rich Harden, Kenny Rogers, Jose Contreras, Randy Johnson, Ervin Santana, Freddy Garcia, A. J. Burnett, and Barry Zito. These ten pitchers will make a combined $76 Million in 2007, but so far have accumulated a record of 40-66. Granted, many of them have spent significant stretches on the DL, which is why Willis seems to most fit the moniker "curse." The former Cy Young runner-up has not won a game since the end of May. He's dropped nine straight decisions. His ERA is a full run higher than in any of his previous four seasons. He's on pace to walk the most batters in his career, while striking out the least. Because of age and histories of injury or inconsistency, we could have probably foreseen the potential struggles of all these pitchers save Santana, Carpenter, and - especially - Willis.