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The Strike Zone

O's Bundy needs Tommy John surgery, as PRP therapy strikes out again

Dylan BundyDylan Bundy has not pitched in either the majors or the minors this season because of injury. (Mark LoMoglio/Icon SMI)

Orioles pitching prospect Dylan Bundy will have Tommy John surgery on Thursday just two months after being told there was no structural damage in his elbow and being prescribed a treatment of platelet-rich plasma injections. PRP therapy has become a popular alternative course for players hoping to speed their recovery from soft-tissue injuries over the last half decade, but the lack of the treatment's success in Bundy's case is just the latest example of its ineffectiveness in restoring players to full health or in preventing players from needing surgery at a later date.

In addition to Bundy, the Dodgers' Chad Billingsley, the Cardinals' Jaime Garcia and Rafael Furcal, the Braves' Johnny Venters, and the Giants' Angel Pagan all attempted to avoid major surgeries through PRP therapy this year, and all five have since gone under the knife. Of that quintet, all but Pagan have had their seasons ended by their surgery, with Billingsley, Furcal, and Venters joining Bundy as Tommy John patients, and it's entirely possible that Pagan won't return this season either.

Last May, Matt Kemp turned to PRP therapy to speed his recovery from a hamstring injury in late May only to reaggravate the injury in his second game back from the disabled list and miss another month and a half. In August, David Ortiz turned to PRP injections following an Achilles tendon strain suffered in late July and not only proved unable to come back that season, but missed the first three weeks of this season as well. Fallen Blue Jays ace Ricky Romero had PRP injections in his knees last October but experienced no improvement, has spent most of this season in the minors and was outrighted off the Jays' 40-man roster at the end of May.

This is admittedly anecdotal evidence, but it's been difficult to find the same anecdotal evidence of the therapy working with the single exception of former Dodgers closer Takashi Saito, who reportedly used the therapy to avoid Tommy John surgery in 2008. However outfielders Xavier Nady, in 2009, and Carl Crawford, in 2012, provide additional examples of players having the surgery despite their efforts with PRP, while then-Mets Jose Reyes and Carlos Beltran both turned to the therapy to treat leg injuries in mid-2009 only for Reyes to miss the remainder of the season and for Beltran to turn to surgery that offseason.

It may be that the other players listed above all were trying to treat injuries too severe for PRP injections to fight, even in conjunction with carefully prescribed rest and rehabilitation. Still, if that's the case, that greatly diminishes the therapy's standing as an alternative to major surgery, if not completely obliterates it. PRP may be effective in relieving the discomfort of tennis elbow or other inflammatory and osteoarthritic conditions, but it's not going to heal a tear.

At this point, it seems all that PRP treatments are doing is delaying players' surgeries and thus extending the period of time during which they are either diminished or altogether absent.  Having already lost this season, Bundy, having put off his surgery for two months, may not return until the later half of next season, putting even more distance between the day when he was drafted fourth overall by the Orioles and the time by which he can become a fixture in Baltimore's rotation.

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