The term “Tommy John Surgery” is a scary one within the framework of baseball – and fantasy baseball. It is something that needs to be considered as a long-term detriment towards performance expectations when evaluating players, and is something that is most commonly associated with pitchers. Named after the baseball player Tommy John, since he was the first person to ever require such a surgery, it is something that happens once the band of tissues in the elbow, called the ulnar collateral ligaments (UCL), get completely torn from the bone, causing there to be no connection amongst the bones within that elbow.
The tearing is not usually a sudden tear (like a band-aid rip), but rather a gradual tear that happens every single time a pitcher throws a ball at or close to his maximum effort. Think of it as every pitch thrown at a certain high effort being similar to drops of water entering a cup, and once the cup is full it will overflow. That falling over of water outside of the cup is the UCL being torn. Once there is a tear, it makes the pain almost intolerable, thus requiring that player to have the surgery of filling that empty spot of tissue band with other tissue from a different place on the body in order to fix it. If a player undergoes this type of surgery, it usually means extended time off with a ton of rehabilitation.
Keeping all of this in mind, I thought I would explore some of these situations more intently and figure out exactly where we stand heading into the 2022 season. For reference of dates, I will be using a phenomenal resource that was created by Joe Roegele, which lists every player that has ever had Tommy John Surgery, the amount of time missed and even lists the doctors that performed the operation. Personally, I was thoroughly impressed with the amount of research and work that went into this.
Before moving forward, however, it’s important to understand the healing process associated with getting a pitcher back to full strength. When there is an arm injury, pitchers rarely use that arm for anything more than what is a normal everyday function. Essentially, it is to be rested as much as possible before re-evaluation. Once a suitable timeframe has been established, there are many different tasks that a pitcher can progressively attempt that will slowly put pressure back on the arm to see if the injury can not only heal but also get back to its previous level. They are “interval-ish” in nature, meaning that they start off incredibly light and work their way up in intensity. While each injury and athlete are all unique in nature, the generalization of these tasks are respective guidelines to help an athlete get back to his/her peak health and performance level. While the entire process can be very detailed and complicated for varying pitchers, the general idea is a progression looking somewhat like this:
Light Toss (catch) >>> Flat Ground >>> Throw From 45′ >>> Throw From 60′ >>> Throw from 90′ >>> Throw from 120′ >>> Long Distance Throwing (greater than 120′) >>> Throwing from a mound >>> Bullpen session >>> Live batters >>> Simulated game >>> Rehab game
Note – a player’s progression starts on the left side and moves along to the right, barring a setback; it is assumed that a pitcher can complete or has completed what is to the left of him.
Note – when progressing through the following player’s timelines, please note the dates, as they have a big indicator of how and where they should be progressing.
Note – any ADP referenced here is the NFBC ADP since February 1, 2022.
With that in mind, here are some of the more prominent names that dominated the Injury Lists in 2021.
Luis Severino – RHP, New York Yankees
Date of Surgery: February 27, 2020
Date of Return: September 21, 2021
Months Missed: 19
Days Missed: 572
Final 2021 stats: 6.0 IP, 0.00 ERA, 0.50 WHIP, 8 K, 1 BB
After a phenomenal two-year run in 2017 and 2018 and giving the Yankees a glimpse into their prospective future, Severino spent most of 2019 with an inflamed rotator cuff before making his debut late in the year. Unfortunately, he was limited to just 12 innings that year and was required to have Tommy John Surgery late in February 2020, costing him the entirety of that shortened season. Despite this, many fantasy players still drafted him in the middle or end of drafts as a sort of stash and hold-type player, hoping to cash in on a return to the previous form later in the season. Throughout the year, he had his ups and downs.
Mike Harkey, on watching Luis Severino's bullpen session:
“I’ve seen a lot of first-time bullpens after Tommy John, and watching Sevy’s is probably the most comfortable I’ve ever seen a player throwing in his bullpen – and probably the most aggressive I've seen a player."
— Bryan Hoch (@BryanHoch) March 13, 2021
This would have been about one year after he had the surgery, which, although is perfectly fine within the confines of his recovery, is seemingly a best case scenario. Keep in mind, that Severino also had a bone chip in his elbow removed during the operation. Still, all was looking okay and he even accelerated his return a few weeks later.
Luis Severino will toss three simulated innings today, plan is for him to begin a rehab assignment this Sunday, per Boone.
— Pete Caldera (@pcaldera) May 31, 2021
It was my opinion at the time that his progress was seemingly moving along too fast, but alas I am risk-averse in nature and I am not a doctor or a medical professional. Still, although Severino made it through some of his rehab assignments, he strained his groin, thus setting him back in his projected return, and putting him on the Injured List for a separate injury. As a general aside, after returning from longstanding injuries that require a lot of time and maintenance, there’s a chance that other body parts either over-compensate, get neglected, or move in ways otherwise not traditionally done since the pitcher may now be hesitant to throw at 100%. I’m not saying that this is what happened here, and it may be something different altogether, but it’s something to consider. Weeks later, Severino made his way to the Yankees’ Double-A affiliate and made a rehab appearance.
Here’s some highlights from Luis Severino’s first rehab start for the Somerset Patriots.
2.1 IP, 43 P, 28 strikes, 2 H, 1 HR, 2 R, 1 BB, 4 K’s. Reached 95 MPH w/FB. Breaking stuff looked strong. Only mistake was fastball middle-middle to Rutschman. pic.twitter.com/qnXtP5aWzw
— Eli Fishman (@elijfishman) August 4, 2021
It was very promising seeing his fastball velocity that high, and it seems like his secondary pitches looked good. Still, at only 43 pitches in total he had a ways to go. A few weeks later, he helped other Somerset pitchers combine for a no-hitter, showing to everyone that he looked just about ready….except that he then got scratched from his Triple-A debut start because his shoulder didn’t feel right. After an MRI revealed that there was no structural damage, he threw simulated innings for the Yankees, skipped his scheduled Triple-A rehab altogether, and returned to the Yankees in a relief role on September 21. It was here that started his 2021 season, at Game 152 for the Yankees, and he pitched a total of six innings to end the year.
While obviously a small sample, it’s still important to note the drop in velocity of the fastball.
Summary: Severino came into the 2021 season with thirteen months of rehabilitation under his belt. The Yankees’ staff seemingly liked what they saw, but his body gave way to other injuries while attempting to break through the final stages of recovery. Even when he did return to the Major League level, he was thrust into a relief role where he threw no more than 37 pitches. It was a slow return, which leads me to believe that had he not suffered those setbacks earlier in the calendar year, he may have been inserted into the Yankees’ rotation at some point in early August, but that’s just my own speculation. Who’s really to say that he wouldn’t have had an extended relief role months earlier in order to be protected from further injury down the line. As we move along towards 2022, I’m relatively confident he will be able to contribute as one of the Yankees’ best pitchers, but given his injury history, it wouldn’t surprise me if they ease him back into the rotation. With an ADP around 184, I would cautiously draft him around that mark, and would also want at least two other safe options already on my team.
Noah Syndergaard – RHP, New York Mets
Date of Surgery: March 26, 2020
Date of Return: September 28, 2021
Months Missed: 18
Days Missed: 551
Final 2021 stats: 2.0 IP, 9.00 ERA, 1.50 WHIP, 2 K, 0 BB
Syndergaard burst onto the scene in 2015, and for years tore through the competition with a high 90’s fastball and sinker. He was a fan favorite, an important piece of the puzzle for the Mets, and losing him around the beginning of the pandemic was heartbreaking for fans and fantasy owners alike. His surgery went exactly as planed, and he was recovering when all of a sudden, Thor himself posted this video:
— Noah Syndergaard (@Noahsyndergaard) November 12, 2020
Fans rejoiced, as this was a bit surprising, since it was only about seven months after his surgery, which looked to be coinciding with the general schedule for recovery. A month later, some news out of Mets’ camp came out about the possibility of a return, stating:
Noah Syndergaard is "on schedule or maybe a little bit ahead of schedule" in his rehab from Tommy John surgery, Luis Rojas said.
It has always seemed like a long-shot for Syndergaard to be ready for Opening Day. Some point in the first half seems more likely.
— Anthony DiComo (@AnthonyDiComo) December 16, 2020
Essentially two positive pieces of news within a month, and fans dreamt of the possibility of him only missing a month or so of action. This was very optimistic in that what was being presented should have been considered the best-case scenario for a return from such a major arm-related injury. As the Mets came into Spring Training, Syndergaard threw a side session where he reportedly looked good. Eventually, he progressed even further as he threw some sliders, which is a very positive step forward, since throwing secondary pitches with movement requires even more movement from the arm and wrist, causing all inter-connected parts to work together.
Still, all within that timeframe, Syndergaard was placed on the 60-day IL which disqualified him from playing until at least the month of June; that should have been a stop sign on the road of encouragement for fantasy owners. As the months rolled along, he succeeded on many levels, from throwing on a mound to progressing to live batters and even making some rehab appearances for the Mets’ farm teams. Then, after a miserable start where he lasted just one inning in which his fastball had significantly diminished velocity, the Mets revealed news that scared everyone.
BREAKING: Noah Syndergaard has been shut down for six weeks with right elbow inflammation. No structural damage, but he'll be down until at least August.
— Anthony DiComo (@AnthonyDiComo) May 27, 2021
While precautionary, this especially hurt the Mets, who were relying on Syndergaard to return. It’s unfortunate for him, too, since there was a lot of pressure on him to perform so quickly after an injury that requires the body to learn and adapt to its newfound limitations. Over the next few weeks he made his way along the aforementioned pitching progress line, but was advised to do so cautiously as he was told not to throw his sliders for awhile. Still, Syndergaard continued to work, and despite a brief bout of Covid-19, he found himself ready to contribute. He eventually returned to the Mets and made his debut late in the year. His pitching repertoire consisted of only three pitches, all of which were down in velocity. He has since left the Mets as a free agent and joined the Los Angeles Angels as a free agent. While it’s possible to think that he should rebound in 2022 after having the next four to five months off for his body to heal even further, there was one concerning development for him and the Angels.
Heard Syndergaard camp told interested teams decision on Monday, so can take physical Tuesday (which he is doing for the #Angels) so in case he didn’t pass, he could always just take the #Mets $18.4M qualifying offer by 5pm Wednesday deadline.
— Joel Sherman (@Joelsherman1) November 16, 2021
Summary: The Mets were very similar to the Yankees here, in that they liked what they saw in Spring Training, they pushed forward after the minimal timetable, and subsequently suffered due to physical consequences. Syndergaard did eventually return, albeit in a relief role, and pitched with diminished velocity. Like Severino, one has to wonder how long this relief role would have lasted had he returned earlier on track, but the fact remains that he had an 18-month absence due to setbacks and complications. Heading into 2022, I am not as confident in Syndergaard as I would have been had he done more in 2021. I will be cautiously optimistic that he will return to fine form, but will definitely be monitoring his Spring Training, with a watchful eye on his velocity. The fact that he was worried about failing his physical is concerning. With a current ADP around 220, I would look for other options around that range.
Chris Sale – LHP, Boston Red Sox
Date of Surgery: March 30, 2020
Date of Return: August 14, 2021
Months Missed: 17
Days Missed: 512
Final 2021 stats: 42.2 IP, 3.16 ERA, 1.37 WHIP, 52 K, 12 BB
Entering the 2021 season, I personally projected Sale to be the last of the three now mentioned pitchers to debut, due to the timeframe associated with his injury. His surgery took place later than either of the aforementioned pitchers, he is the oldest of the three, and I didn’t see the Red Sox being as competitive as they were over the course of the regular season. As such, I thought that Boston would be more cautious, work him in slowly and aim for a full 2022 rebound. Going back in history, Sale missed the latter part of the 2019 season and waited until the offseason for a follow-up appointment following a platelet injection in mid-August. After getting medically cleared, he found himself on the Injured List to start the 2020 season, before the pandemic hit, and was then diagnosed with a flexor strain after not feeling right when throwing. Once the pandemic hit, the Red Sox decided to go with the route that they hoped to avoid:
LHP Chris Sale today underwent successful left UCL reconstruction (“Tommy John surgery”).
The procedure was performed by Dr. Neal ElAttrache at the Kerlan-Jobe Institute in Los Angeles, CA. #RedSox
— Red Sox (@RedSox) March 30, 2020
At the time, there was no indication that baseball would be resuming anytime soon, so the idea of missing at least a year to heal a nagging problem was necessarily a bad one. By the end of the 2020 season, Sale had already begun a throwing program that began with playing catch. Red Sox management indicated there was no chance of him being ready for 2021 Opening Day either, which seemed unrealistic anyway, since it takes more than one year to return to competitive pitching. This is the main difference between Boston and New York, as the Red Sox were very cautious in returning their star pitcher, while the Mets (and Yankees) seemed to want to push the boundaries:
As the weeks and months labored on, so did Sale’s progression, as he took his time with each of the steps indicated in the previously mentioned rehabilitation timeline. In fact, he didn’t even throw off of a mound until May, which was 13+ months after his operation. He slowly incorporated his secondary pitches and stretched himself out over many minor league appearances, not pushing the envelope. It seems the Red Sox had a well-developed plan of what they wanted to do, and sticking to it outweighed the potential for long-term setbacks. When he finally made his debut for the Red Sox in 2021, it was after a 90-pitch minor league rehab performance, giving notice that he was ready to perform at the highest level. What transpired for Sale was a pretty successful season that looked very similar to his 2019 numbers in pitch performance.
Summary: Chris Sale came into this season with the shortest window of injury-time yet was the first to successfully make his return to baseball. It is definitely worth noting that management took a safe and cautious approach that resulted in his body gradually and naturally making itself ready to perform. Heading into the 2022 season, there is minimal doubt in my mind that he will be ready to handle the workload of a regular season, and as someone with three pitches, he should be able to get back to his old dominating ways. With an ADP around 63, however, I would want him to be at most my second pitcher, not my ace.
What Have I Learned?
It’s a rather interesting development, as all three pitchers had Tommy John Surgery around the same time. Heading into the 2021 season, they were all being drafted as pitchers that were expected to help fantasy owners down the line. The timelines of Severino and Syndergaard are curious in that it seemed likely both teams tried to accelerate their returns by pushing their players forward with their development. The Red Sox and Sale, on the other hand, understood the gravity of the situation and kept along the same path. Does this hold true in most cases….it’s hard to say, but I would guess so. My takeaway here is to monitor the recovery of any injured player to see not only what he is doing, but also if it corresponds to an appropriate timeline.
As stated at the beginning, there is a long list of things that a player should need to be able to do, and rushing someone through those hurdles can have long-term implications and setbacks. As with any injury, it’s important to understand what the injury is, the typical ways to rehabilitate, and the situation with regards to the team on which he is playing. Monitor them and make your judgments in an educated fashion. Pitchers such as Tyler Glasnow (surgery on August 4, 2021), Dustin May (May 21, 2021), and James Paxton (April 14, 2021) all had Tommy John Surgery last year, and none should be counted on for anything substantial in 2022.
Keep a watch on how their respective teams are managing their progress. Use the step-by-step parameters that were listed up top as a general timeline, and if you see them skipping through some steps, perhaps their return gets delayed with similar problems and setbacks. That being said, all should be considered buy low opportunities, in the order, they were listed, in dynasty formats for a 2023 return. As for the three pitchers in question from earlier, my level of confidence heading into 2022 is as follows (out of five stars):