New York Yankees Ace's Complete Surgical Procedure Explained

New York Yankees ace Gerrit Cole underwent his elbow surgery earlier this week, as expected. The procedure itself was probably what the Yankees, Cole and his surgeon expected.

So, what, exactly, does it all mean?

In preliminary reporting by MLB.com and other outlets, Cole's procedure was described as UCL surgery that included internal bracing. That is not a Tommy John surgery in the traditional sense, but a newer procedure designed to improve strength, cut down on recovery time and reduce the chance for post-surgical setbacks.

Later, the Yankees clarified that Cole had complete UCL reconstruction, which included internal bracing.

That means that Cole did have the traditional Tommy John surgery, which is a ligament replacement where the surgeon takes a tendon from another part of the body and replaces the torn ulnar collateral ligament.

But it also means the surgeon used it in combination with the new procedure, which can be an alternative, depending on the severity of the tear, or be used in combination.

An internal brace is significantly different in two ways.

First, there’s the “internal brace.” It’s not metal, though the term makes it sound that way. It’s actually collagen-coated tape that is placed in the ulna bone with small bone anchors.

Second, according to the New Jersey Orthopaedic Institute, it means the surgeon repaired the torn UCL with sutures, as opposed to grafting in a new ligament.

By doing this, the surgeon would fix the brace in place after the ligament was repaired and then perform range of motion exercises on the patient to ensure the installation was correct.

With a full reconstruction, Cole received a new UCL ligament and the internal brace.

What does this mean for Cole's recovery time?

With the initial reporting, there was a belief that Cole could be back in 12 months. Was that really possible?

Fangraphs compiled a list of five pitchers that had the UCL with internal brace that returned to the Majors, based on Jon Roegele’s Tommy John surgery database. From surgery date to return date the timetable ranged from nine months for Seth Maness in 2016-17 to 18 months for Nick Anderson in 2021-22. Anderson’s surgery happened in October of 2021 so he basically missed all of 2022 and had to wait for opening day of 2023.

The site also listed four pitchers that had the procedure and never returned to the Majors, including Sean Doolittle. All of these procedures were done on or after 2016.

Now that it's clear that Cole had the full reconstruction and not just the internal brace, a more traditional timeline, which can be anywhere from 12-18 months, is more likely, with a lean closer to the 18-month time frame.

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