Diamondbacks Hospital: Double Tommy John edition

It is not unprecedented for a player to have more than one Tommy John surgery in their career. Indeed, the leader in this area appears to be Jose Rijo, who had the operation three times (often reported as five, but it appears to be three TJ and two other arm surgeries), causing him to go almost seven years between major-league starts. By the third time, the Cincinnati Reds' medical director, Tim Kremchek, said "We're not really sure how much of Jose's ligament is there," and the fact Rijo had an arthritic elbow actually worked in his favor, helping to stabilize the joint. Added Kremchek concerning Rijo, "His regular body is 30. But his elbow? His elbow is 86."

So it is possible for a player to come back from double TJ. But likely? That seems much more in doubt, especially because few pitchers have their surgeries in the manner to be experienced by Hudson, only a year apart. While he won't be alone, Braves reliever Johnny Venters went under the knife for TJ #2 last month, Venters' situation is much more common. The majority have one TJ early in their career - Venters had his first in 2005 - and then another one a significant number of seasons later, which seems like a significantly different situation from Daniel. Brian Wilson and Joakim Soria are similar, having about nine years between operations; neither man has yet returned.

Will that help or hinder him? It's hard to say. Some of the factors which make doubling down problematic are there, regardless of when it takes place. Tommy John guru, Dr. James Andrews said, "You can always get it redone, but it won't be as good as the first time." That's because it generally involves transplanting a tendon from elsewhere in the body, and the best, strongest candidate is used the first time around. Dr. Frank Jobe, who did the original operation on Tommy John, elaborated on the reasons: "One is that some people just don't have as good ligaments as others. The other is that pitchers sometimes come back with bad habits and try to throw too hard, too soon."

So, with those caveats in mind, here's a list of all the pitchers I could find, who have had double Tommy John surgeries. along with the results after the second operation (GS = games started, GR = relief appearances). The list excludes any still rehabbing ones, such as those mentioned above, and also those who didn't reach the majors in significant volume before and/or after.

As you can see, it's all over the place. The gamut runs from those like Capuano, who have more or less been able to continue pitching, at a similar level to where they were pre-surgery, down to a disturbing number whose careers were tagged with the three-letter acronym of death, DNR. We are dealing with small sample sizes here, and it's almost impossible to come up with any trends, but it seems to me that pitchers who are younger at the time of their second surgery have a better chance of returning, and it's something which (outside of Capuano) appears to be more common for relief pitchers. Maybe we'll see Hudson come back in the bullpen?

There's no denying, while the success rate for first surgeries is now very high, the consensus is that the second one is a much more fraught proposition. Estimates vary, but it has been said that "from 10 to 25 percent of those pitchers" return to pitch effectively in the majors. But, speaking in regard to Venters, Braves' GM Frank Wren more or less nailed it. "It really is an individual outcome based on the player and his body and the rehab and all those things. But there are players who have actually pitched better after their second than they did after their first. There are players that have not. I don’t know that you can say for certain how a player is going to come out."

It's understandable that Hudson seriously contemplated hanging up his spikes, after going through a year of waiting and finally getting to throw, only to find himself back to square one. He said, "I'd say for a good couple hours after I found out the news, I was fifty-fifty, just because I didn't know mentally if I could do it again... I didn't even want to see anybody the other day. I just sat at my house and tried to make sense of it, but that didn't work... Just 12 months of watching baseball and not doing anything. It was a tough few hours for us. But people have it way worse than I do, so I figured if I didn't get it done, if I didn't try at least, I couldn't look myself in the mirror in five years."

All we can do now is hope that Hudson is among the percentage, whatever it may be, that are able to return, as strong as they were before. It's a tough road, but if anyone can do it, Hudson can, and we'll all be pulling for him. I'll be back on Thursday's off-day, with the regular update on the other DL'd D-backs.