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Is Tommy John surgery in Alex Cobb's future? With the righthander reportedly suffering a torn ligament in his elbow, his season and the Rays' contention hopes take a big hit.

By Jay Jaffe
May 06, 2015

Coming into the season, the Rays' chances of contending for a playoff spot rested heavily on the strength on their starting rotation. Even with James Shields and David Price both gone, the unit headed by Chris Archer and Alex Cobb appeared to be one of the best in the division or even the league. But injuries have already taken their toll, and now it appears as though Cobb's season is in jeopardy. Via the Tampa Bay Times' Mark Topkin, Cobb has a partial tear in his ulnar collateral ligament and could eventually face Tommy John surgery.

The 27-year-old Cobb has spent parts of the last four seasons in the Rays' rotation, making a total of 81 starts with a 3.21 ERA (118 ERA+) and a 3.43 FIP. Last year, he pitched to a 2.87 ERA (130 ERA+) in 27 starts totaling 166 1/3 innings, but it marked the third season out of four in which he missed substantial time due to injuries; he lost nearly six weeks to an oblique strain. In 2011, he missed roughly two months after undergoing surgery to correct thoracic outlet syndrome, and in '13, he lost another two months after taking a line drive off his head, suffering a concussion.

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In early March, the Rays anointed Cobb to be their Opening Day starter, but those plans were scrubbed after he left his March 17 start with forearm tightness. Initially diagnosed with tendinitis, he had been eyeing a mid-May return, but over the weekend, he experienced what the team described as "a setback" in his rehab, and was shut down from throwing. Reportedly, that was actually a diagnosis of the UCL tear via an arthrogram performed during a visit to Dr. James Andrews, during which Cobb also received a platelet-rich plasma injection. Via Topkin, president of baseball operations Matt Silverman described the Rays in "wait-and-see" mode with regards to the next steps, leaving open the possibility that Cobb could return to action after rest and rehabilitation, though the possibility of surgery can't be ruled out.

The situation isn't unlike that of the Yankees' Masahiro Tanaka, who missed 2 1/2 months last year after being diagnosed with a partial UCL tear and received a PRP injection. Tanaka was able to start the year in the rotation, but after four starts, he is now back on the DL in the wake of a diagnosis of tendinitis in his wrist and a forearm strain that's said to be unrelated to his UCL. While signs point to both pitchers eventually undergoing the all-too-common surgery and missing at least a year, the chorus of armchair "cut-him-now" diagnoses from fans and pundits illustrates a lack of understanding about the injury and the surgical risks.

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Not all UCL strains are full tears of the ligament, which no amount of PRP, rest and rehab would be enough to repair; the Mets' Zack Wheeler was one of the recent pitchers unlucky enough to receive such a diagnosis. Tanaka's injury is said to be a 10% tear, while a 25 to 33% tear is the general threshold for surgery. The inference based on the Rays' current course of action is that Cobb’s tear isn't above that threshold, either, giving him a shot at forestalling surgery. Adam Wainwright and Ervin Santana are two pitchers who were able to pitch through partial tears for several years, though Wainwright finally underwent the surgery in 2011.

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Beyond the fact that not all UCL strains are created equal, the reality is that Tommy John surgery carries a greater risk than is often assumed. A recent study by ESPN injury expert Stephania Bell covering 147 major league pitchers who underwent the surgery between 1999 and July 2011 found that while 80% were able to return to "active" status—as defined by pitching in at least one game—13% pitched fewer than 10 games in a season. Only 67% returned to "established" status; one pitcher in three did not, a sobering statistic. Furthermore, Bell found that while looking at performance in the three years after surgery compared to three years before, "Performance metrics for established pitchers post-injury showed a decline when compared to pre-injury numbers in each of the following areas: ERA, batting average against (BAA), walks plus hits per innings pitched (WHIP), percentage of pitches thrown in the strike zone, innings pitched, percentage fastballs thrown and average fastball velocity."

That data (which Bell further details, metric by metric) paints a less-than-rosy picture, one that goes hand in hand with the general principle of treating surgery as a last resort. All of which is to say that while the path to the operating table for any pitcher with a UCL tear may appear inevitable, it's still the decision of the player, his doctor and the team to make the decision as to its timing and necessity, not the media or fans.

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As for the Rays, they haven't totally collapsed in the absence of Cobb or of Drew Smyly, who missed the first three weeks of the year with shoulder tendinitis. The team is second in the AL East at 14–13, three games behind the Yankees and tied with the Twins for the second Wild Card spot—not that anyone should start printing playoff tickets. Archer (1.64 ERA, 2.88 FIP) and Jake Odorizzi (2.21 ERA, 2.20 FIP) have both pitched exceptionally well through six turns, Smyly has posted a 2.75 ERA in three starts since returning, and Nathan Karns (4.05 ERA) has been around league-average. Four other pitchers—Erasmo Ramirez, Matt Andriese, Alex Colome and Steve Geltz—have made either one or two starts, none of them quality, but even so, the unit as a whole has the league's lowest ERA (3.17), third-lowest FIP (3.41) and second-highest strikeout rate (23.1%). If one excuses the short leashes of the aforementioned fill-in starters, the front four's 52% quality-start rate would rank third in the league.

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Additional help is on the way in the form of Matt Moore, who on Sunday threw to hitters for the first time since undergoing Tommy John surgery last April. Barring a setback, he's eyeing a mid-to-late June return. In the meantime, the team is going forth with Colome as the fifth starter. Once a top prospect, the 26-year-old righty's star has fallen somewhat due to injuries and a 50-game PED suspension at the beginning of last season. After returning from the suspension, he pitched to a 3.77 ERA with 7.6 strikeouts per nine in 86 innings at Triple A Durham and made five appearances (three starts) for the big club. In parts of three big league seasons, he's put up a 2.22 ERA and 3.93 FIP across 44 1/3 innings, with his success owing more to a .250 batting average on balls in play than to dominance in the strikeout and walk departments. That said, he was impressive in his 2015 debut on May 1, delivering five scoreless innings and limiting the Orioles to three hits without a walk, striking out six.

There’s no guarantee Cobb will return this year, but if he does, he'll augment a staff that's currently in a virtual tie for second place in the league in run prevention, at 3.59 runs per game. No matter his fate, however, there's not much he can do to help an offense that's second-to-last in the league in scoring at 3.56 runs per game, but that's a problem for another day.

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