For the past year and a half, the name Stephen Strasburg has sent bolts of electricity through the nervous systems of baseball fans, scouts, and players, but for the next year -- if not more -- it will provide us with nothing more than frustration. After just 12 tantalizing major league starts, Strasburg's right arm gave out on him in the fifth inning of his start against the Phillies last Saturday. On Thursday, the results of his enhanced MRI came in, and they were not good. Strasburg has been diagnosed with "a significant tear" in his pitching elbow and is apparently headed for ligament-replacement, a.k.a. Tommy John, surgery, which will likely to keep him out of action through the end of the 2011 season. That's a huge blow to the Washington Nationals and to major league baseball and its fans in general, as all have lost a captivatingly unique young talent for more than a calendar year, but what exactly does it mean for the burgeoning career of the 22-year-old pitcher actually having the surgery?
Finding a Tommy John success story is as easy as checking the box scores. There are at least 43 pitchers on active major league rosters who have had Tommy John surgery at some point in their careers, including both starters in Thursday night's game between the Nationals and Cardinals, Washington's Jordan Zimmermann and St. Louis' Chris Carpenter. Other Tommy John alumni include starters Josh Johnson, Tim Hudson, Jaime Garcia, Francisco Liriano, Carl Pavano, Ryan Dempster, A.J. Burnett and C.J. Wilson, ace set-up men Arthur Rhodes and Hong-Chih Kuo (who had it twice), and closers Joakim Soria, Rafael Soriano, Billy Wagner, John Axford, Brian Wilson and Mariano Rivera. More than 11 percent of the active pitchers in the major leagues are Tommy John survivors, and that percentage has shown some consistency going as far back as the 2002 and 2003 seasons, when, according to a July 2003 USA Today report, one in nine pitchers appearing in the major leagues had survived the surgery.
Finding a major league pitcher who was unable to return from the surgery is far more difficult. In a 2009 interview, Red Sox head trainer Mike Reinold put the success rate of return from the surgery at "close to 85 to 92 percent in elite pitchers." In 2003, Dr. Frank Jobe, who invented the procedure, told Jayson Stark the success rate was 92 to 95 percent, if not better. A success rate of 92 percent would mean that for every 43 successes there would be fewer than four failures, but pinpointing those failures can be difficult.
For example, former Orioles and Blue Jays closer B.J. Ryan had Tommy John surgery in May 2007. A year later, he returned to the Jays and saved 32 games while posting a 2.95 ERA and striking out one man per inning. However, Ryan was awful in early 2009 and, after struggling with his velocity in the minors, Ryan asked for his release and hasn't pitched since. That strong 2008 season confused the matter, but according to FanGraphs' pitch data, Ryan's average fastball was two miles per hour slower in his comeback season of 2008 than in his last healthy season of 2006, and his slider had lost its effectiveness, which suggests that despite that one successful season, he was never the same pitcher after the surgery. A more clear-cut failure was that of former Rangers closer Jeff Zimmerman, who had Tommy John surgery in 2002 and, despite two subsequent elbow surgeries, including a repeat of the T.J., has never thrown another big league pitch.
Of course, with so few Tommy John failures out there, and more of them being muddled as with Ryan than obvious as with Zimmerman, there's not a lot we can learn from them. After all, the ability to recover from injury, or to avoid it in the first place, has as much to do with genetics as mechanics or conditioning. By looking at some of the successful comebacks, however, we can get a general impression of what the next few years have in store for Strasburg.
To start with, the recovery time for Tommy John surgery, from the moment of the incision to the next major league pitch thrown with that arm, is generally 12 months. Strasburg's teammate Jordan Zimmermann had his T.J. surgery in mid-August of 2009 and made his return Thursday night, August 26, 2010. Reds ace Edinson Volquez had his surgery on August 3, 2009 and returned on July 17, 2010. The Blue Jays' Shaun Marcum had his T.J. in late September of 2008 and missed all of the 2009 season, but has been healthy and effective throughout the 2010 season. Similarly, Cardinals then-prospect Jaime Garcia had Tommy John surgery after the 2008 season, missed all of 2009, then secured the fifth spot in the Cardinals' rotation this spring and is the leading candidate for the National League Rookie of the Year award. (For those wondering, Strasburg has already lost his rookie eligibility.)
Given the timing of Strasburg's injury and impending surgery, the Nationals could follow either two courses of action. They can keep him out for all of the 2011 season to avoid rushing him back and give him four more months in the off-season to heal, or, as they did with Zimmermann (who is expected to be the team's ace in Strasburg's absence) can let him make some low-pressure starts in September of next year to get used to facing big league hitters again. Most likely the pace and strength of Strasburg's rehabilitation, not some pre-ordained plan, will set the Nationals' course there.
And what can the Nats expect whenever Strasburg does return? Its is often said that while it takes a year to rehab from Tommy John surgery, it can take another year for the pitcher in question to regain the velocity and command he had prior to the injury. In the case of would-be Twins ace Francisco Liriano, it took even longer. Liriano had Tommy John surgery in November 2006, missed all of the 2007 season, and upon returning in 2008, found he had lost four miles per hour off his fastball and slider, and his slider and changeup were noticeably less effective. Liriano saw only minimal improvement in 2009, but finally this season, more than three years removed from his surgery, Liriano has his fastball back up around 94 miles per hour and is getting the nasty, put-away action on his slider that he had in 2006.
Far more encouraging is the experience of Marlins ace Josh Johnson, who had Tommy John surgery on August 3, 2007, returned to the majors on July 10, 2008 and was immediately throwing harder than had been before surgery. It's a bit of an urban legend that ligament-replacement surgery can add velocity to a pitcher's fastball; more likely the surgery corrects a problem that had been slowing down that pitch. One also has to consider a pitchers' physical maturity. Johnson is 6-foot-7 and broke into the majors at the age of 21 throwing about 91 miles per hour. He increased his velocity a bit in each of the next two seasons even before his surgery, throwing just over 92 miles per hour on average in 2007. When he returned, however, he hit the ground running at more than 93 miles per hour and has had an average fastball speed of roughly 95 mph in the two seasons since. Perhaps more significantly, Johnson's slider, a pitch commonly associated with elbow ligament damage, had lost its effectiveness in 2007, but has again been his bread-and-butter since his return. Johnson has gone 33-11 with a 2.98 ERA, and 3.42 K/BB in 73 starts since returning to action.
Liriano and Johnson are decent comparisons for Strasburg. Both were top prospects (Liriano moreso than Johnson) and both throw in the mid-90s when healthy. Johnson was 23 when he had his surgery, while Liriano was, like Strasburg is now, 22. Assuming Strasburg avoids becoming a rare Tommy John casualty, Liriano and Johnson also likely represent the two extremes of the pace of his recovery. The bad news is that, even if he does come all the way back, on the Liriano plan it could take Strasburg until 2014 to again dominate major league hitters. The good news is that both Johnson and Liriano ultimately did make a full recovery.
Of course, there is no perfect comparison for Stephen Strasburg (quick, name another pitcher with three dominant offering who averages 97 miles per hour with his fastball and thus throws his changeup at almost 90 . . . didn't think so). That makes projecting the post-surgery Strasburg additionally difficult. It seems entirely possible that Strasburg could lose three miles per hour off his pitches and still throw mid-90s heat and dominate in the majors, though he'd seem disappointingly ordinary if he did. Unfortunately, the only way to find out is to wait.