Tommy John surgery used to be viewed as a risky procedure. The rate at which players returned from the surgery wasn’t great. It still was better than shoulder surgery, but the rate of recovery today is so much different. Today we, the general public, tend to think that everyone comes back from Tommy John surgery and returns to form with time. Fangraphs has posted two articles related to Tommy John surgery over the past few days and they both got me to thinking.

This morning Travis Sawchik wrote an article named”Have We Passed Peak Tommy John?”, and it notes that Tommy John surgeries have declined each of the past two seasons. In 2014, then in 2015, the surgery peaked at record highs. The 2017 season was the lowest total since the 2011 season. The decline could simply be random variance, but perhaps teams are doing things a little better overall in injury prevention, too.

With all of the injuries to elbows these days, Tommy John surgery is rather common. We usually see guys come back from the injury, and while plenty of guys will have some “rust” when they return, particularly with control, a lot of the guys do come back to close to who they were. But, most of the guys we see return are the Major Leaguers. The guys that were already among the best pitchers on the planet.

What we don’t always see is guys in the minors return to form. On Sunday at Fangraphs, David Laurila talked about and with Brady Aiken about his career. For those who don’t know, Brady Aiken was the #1 overall draft pick in 2014. The Houston Astros selected him and then during his physical noticed that his UCL was abnormally small. They, in turn, decided to drastically lower their offer of a signing bonus to Aiken, almost cutting it in half. He stood his ground and the two sides never agreed on a contract.

The next spring he was pitching for IMG Academy in Florida, preparing for the 2015 draft, and in his first game he tore his UCL. The Cleveland Indians would take a chance and draft him with the 17th overall pick later that summer despite the injury. He would miss the entire 2015 season, of course.

In 2016 Brady Aiken didn’t return to the mound until the rookie season began. The Indians took it slow as he didn’t pitch beyond the 3rd inning until his 7th outing. In his 9th start he threw 5.0 innings, and reached at least the 5th inning in five of his final six innings. There were some stumbles along the way. He posted a 5.83 ERA in 46.1 innings and gave up more hits than he had innings. But, he struck out 57 batters. His walk rate was high, but not insanely high, giving up 21 free passes on the year in his limited inning.

In 2017, things were a bit different. Pitching in rookie ball is a lot different than pitching in full-season baseball. Out in spring training, where the Reds and Indians share a facility, I had heard someone talking about Brady Aiken and how his stuff just wasn’t where it used to be. That held up during the season, too. He spent the entire season in the Midwest League, where the Dayton Dragons play. I spoke with a few people who see the league throughout the year and the reports on his stuff were mostly iffy. Fastball in his high 80’s. Inconsistent offspeed stuff, but a good breaking ball when he’s at it’s best. Poor control.

His stats during the season were poor, to say the least. His ERA was 4.77, which wasn’t terrible, but not good. It was the rest of the numbers that were concerning. In 132.0 innings he allowed 134 hits. That also came with 101 walks and just 89 strikeouts. There’s still time, but this far out beyond Tommy John surgery, most players are back up to their past velocity. They are also beyond the “rust” portion of working through control battles.

While I certainly don’t want to write off a guy like Brady Aiken, it does just bring me back to the original point I was shooting for: Not every Tommy John surgery is a fix-all. The surgery has come a long way since it was originally performed. It’s come a long way in the last 20 years. The recovery methods and rehab have also come a long way. Those are both reasons that the recovery rates are much higher these days. But, it’s not a guarantee for anyone. Some guys don’t recover like we expect them to.


24 Responses

  1. JPhillips

    Jeff Passan’s book, The Arm, is a good look at pitching with a lot of time spent on the UCL and Tommy John surgery.

    • Josh

      I concur I read that about 3 or so months ago pretty awesome book.

  2. Hoyce

    Doug -unrelated question to subject above
    But if ur the Reds. Would u entertain trading Castillo to Astros (who reportedly are after a young ace) , who’s not btw
    Return #1Tucker, #2Whitley and someone like #25 prospect Ferrell?
    It would solve a lot of probs for reds.
    And be quite a parlay from straily.

    • Doug Gray

      Not even a little bit. Castillo is around for six more years. He’s a difference maker, right now. The guys you are looking to move him for are unproven, although highly regarded. But, if I’m trying a Castillo, with six full years, and three pre-arb years, I’m only doing it for other proven big league difference maker types with similar contracts. He is not a guy I’d even consider moving for a prospect package.

      • Hoyce

        Not saying I disagree. But u would be parlaying 6 yrs control into 18 yrs. I think as hard as it would be to lose a stud like Castillo. It’s something the Reds have to look at to get a group of studs to mature at a similar time to compete against the big dogs of baseball

      • Hunt4redsoct

        If the Reds have any hope of contending in the next couple years, Castillo has to be at the front end of the rotation. Trading him for position players just does not make sense. Especially unproven prospects. They finally have someone that can be an ace, that’s something you can’t trade away until he gets too expensive

      • The Duke

        If the Braves came calling with Ronald Acuna, Luiz Gohara, and Kyle Wright, you’re still saying no?

      • Doug Gray

        Why you gotta do that to me?

        I’d probably pull that trigger because I think Acuna’s just a different kind of dude.

      • Bill

        Both teams have to believe they are getting equal value in a trade. Castillo’s 2.4 WAR over 101 service days in 2018 projects about 4 WAR over a full season. So the Reds would be looking for the Astros to replace a 24 WAR potential player in a trade. If you’re the Reds, knowing that even really good prospects fall flat, wouldn’t you want more than 2 top 25 prospects to feel like you’re even breaking even on a trade?

        For comparison, for 4 years of Mat Latos, who had averaged 2.5 WAR over the prior 2 years the Reds gave up:
        – a former 4.8 WAR, but at the time declining major league starting pitcher
        – the #33 overall prospect per BA (Alonso)
        – the #53 overall prospect per BA (Grandal)
        – a late 1st round pick (Boxberger) that pitched for the Padres the year he was acquired

        I think the Reds would ask for a better return for Castillo.

      • Doug Gray

        A few things: First, I think that pitching WAR is trash. It’s a garbage stat. Both versions have serious flaws with them.

        Second, one player worth 4 WAR is far more valuable than two players who are worth the combined 4 WAR. A team only has so many roster spots, so being able to get that from one spot leaves more room to add more.

        I’ll agree the Reds would probably ask more for Castillo, but I’m not sure they’d get it. Prospects are worth more today than probably ever before.

      • Bill

        I agree; I think it would be incredibly hard for either team to agree on the value proposition for many reasons. I think the star (or potential star) player will rarely move prior to reaching arbitration under current market conditions. There’s huge uncertainty in projecting future performance which adds risk to a team looking to trade a player with so much potential excess value, there’s little financial risks in retaining young players, and it would take too many high value prospects to balance the equation (as you point out that carries risk on both sides of a possible trade).

        I also think it will be difficult for the Marlins to find a matchup for Yelich for many of the same reasons.

      • Hoyce

        Another issue to consider is that u minimize injury risk when u get 3:1 or 4:1 in a trade. And while none may equal Castillo individually. Together they may well surpass Castillo and all are obviously cost controlled

      • Bill

        Hoyce, I think you’re exactly right. While the probability of a multi-player package all panning out, it does spread injury and performance risk across multiple players while offering cost control and cost certainty across multiple positions.

        My point is simply that these types of trades are hugely risky for both sides. Similar to signing a premium free agent that gets injured or underperforms, these are the types of deals that can really set back an organization.

    • Greenfield Red

      Only way I’d do it is to someone like the Dodgers. Buehler, Verdugo, Alvarez, K. Ruiz, Dustin May, and a couple of others chosen from down the list, and I think the Reds should do it.

    • wes

      Marwin Gonzalas is 28 but he played like 230 innings at short last year w a 98.4% fielding percentage in a career year. He was pretty good in post season too. So maybe?

      Gonzalas, Whitley, Bukuaskas for Duvall and Castillo. Not sure if that makes sense for either side but fair value.

  3. Hoyce

    Doug -another random question?
    Who has better value in 2018? Votto at $25M or trout at $34+M.?

    • Doug Gray

      Trout, and it’s probably not close. Both are likely bargains, though. ZiPS projections are not out for the Angels yet, but the other systems seem to think he’s worth about 8.5 wins. Votto is projected at about 5 wins. 5 wins is worth about $40M in free agent dollars. 8.5 wins is worth $68M. So, Votto would be a +15M player. Trout, however, would be a +34M player.

      • Bill

        Is $8.5M/WAR a valid assumption in all cases or just premium free agents when there are multiple buyers.

    • Colorado Red

      A better value is Nolan Arenado.
      Not only is he a great offensive player (not just Coors field).
      He may be the best defensive 3rd baseman is history.
      (Yes, I did see Brooks kill the Reds in the 70 WS).
      He is signed for this year, and has 1 more year of arbitration.
      I would take him over trout in a heartbeat.
      (I sure I will get some comments here, Cheers )

  4. Cguy

    What if the Astros offered McCullers along with prospects Tucker & say Garrett Stubbs for Castillo? That trade may help both teams.

    • Alex

      Feels like it’s to risky fr both sides. Young players with alot of control left . Rarely do both sides win in a trade. I’d hate to trade Castillo and he does amazing the McCullers struggles. Could go the other way as well. I think it’s best trades like that dont happen and teams work with what they have and try to make them better