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Diamondbacks Hospital: Double Tommy John edition

Probably the worst news of the year to date came last week, with the unfortunate report that Daniel Hudson's elbow needs another Tommy John surgery and, at least, another 12 months out.


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."

"It really is an individual outcome based on the player and his body and the rehab and all those things... I don’t know that you can say for certain how a player is going to come out."-Braves GM, Frank Wren

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.

Name #1 #2 Age at #2 Post-TJ #2 performance
Al Reyes 1995 2006 31 One full season, one partial. 87 GR, 95 ERA+
Brian Anderson 2004 2005 33 Did not return
Chad Fox 1996 1999 28 One full years, parts of six more. 134 GR, 126 ERA+
Chris Capuano 2002 2008 29 Fourth season to date. 79 GS, 90 ERA+
Darren Dreifort 1995 2001 29 One full season, one partial. 10 GS, 60 GR, 97 ERA+
Denny Stark 2006 2007 32 One partial season. 9 GR, 67 ERA+
Doug Brocail 2001 2002 35 Three full seasons, three partial. 288 GR, 104 ERA+
Hong-Chih Kuo 2000 2003 22 Two full seasons, five partial. 14 HS, 204 GR, 112 ERA+
Jason Frasor 1998 2001 23 10 seasons to date. 548 GR, 118 ERA+
Jason Isringhausen 1998 2008 36 Third TJ in 2009. Two full seasons, one partial 112 GR, 97 ERA+
Lance Carter 1996 2000 25 Two full seasons, three partial. 175 GR, 108 ERA+
Matt Beech 1998 1999 27 Did not return
Matt Riley 2000 2005 25 Did not return
Mike Lincoln 2004 2005 30 One full season, two partial. 102 GR, 76 ERA+
Nate Bland 1999 2001 26 One partial season, 22 GR, 77 ERA+
Scott Mathieson 2006 2008 24 Two partial seasons, 6 GR, but now pitching in Japan (64 GR).
Scott Williamson 2000 2004 28 Three partial seasons, 75 GR, 84 ERA+
Shawn Hill 2004 2009 28 Two partial seasons, 4 GS, 1 GR, 189 ERA+
Shawn Kelley 2003 2010 26 Third season to date. 78 GR, 120 ERA+
Steve Ontiveros 1989 1996 35 One partial season, 1 GS, 2 GR, 53 ERA+
Tim Spooneybarger 2003 2005 25 Did not return
Tyler Yates 2002 2009 31 Did not return
Victor Zambrano 1996 2006 30 One partial season, 4 GS, 9 GR, 46 ERA+

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?

"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." -Daniel Hudson

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.