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Tommy John - Not the Only Path

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Rubby De La Rosa, September 14, 2016
Rubby De La Rosa, September 14, 2016
Photo by Norm Hall/Getty Images

When the ulnar collateral ligament is torn, it can end a career. Tommy John is a known path back to pitching. As you likely know, the path is long and rocky. Recently, pitchers have traveled shorter paths. Two examples are Ruby De La Rosa and Seth Maness. Let’s briefly look at what they did. Three caveats are 1) I am not offering medical advice, 2) these are complex and risky medical procedures, and 3) it is likely that I have oversimplified important aspects in my brief looks.

Stem Cell Treatment

How it Works. Cells are removed from the player’s bone marrow or fat. Stem cells are separated and injected into the elbow injury site. Placement inside the elbow can be important. Sometimes the elbow is “prepared” for the stem cells by injecting Platelet Rich Plasma, Platelet Rich Lysate, and/or IV vitamins. During the healing process, stem cells differentiate into needed specialized cells (muscle, tendons, cartilage, bone) to repair the elbow. In addition, stem cells cause other important cells to come to the site of injury, which then cause increased blood flow and release of growth factors that are needed to repair and regenerate the elbow.

Rubby De La Rosa. Early in the summer of 2016, Ruby De La Rosa had a platelet-rich plasma injection. On September 9 and 14, he pitched a total of 88 pitches for the Diamondbacks. On 27 September 2016, he had stem cell treatment. If he is ready by opening day, that is a 6 month recovery time.

A healthy Rubby De La Rosa would be much welcomed by Diamondbacks’ fans. One advantage of stem cell treatment is faster recovery time. Another advantage of stem cell treatment is that this would have been his second Tommy John surgery. The chances of return from a second Tommy John surgery is only 40%, compared to 75-80% for a first Tommy John surgery. It is possible he will move from the rotation to the bullpen to reduce wear on his arm. He has pitched 413 innings over 6 years.

Bartolo Colon. In 2010, Bartolo Colon had stem cell injections in his elbow and shoulder to repair ligament damage and a torn rotator cuff. In 2011, at age 38, he successfully returned to pitching. He was an all-star in 2013 and 2016. He has pitched 3172 innings in 19 year in the Majors. His career innings pitched ranks 111th . Clearly, age did not prevent Bartolo Colon’s success!

Primary Repair Treatment

How it Works. There are two basic requirements for primary repair surgery. First, the ligament is torn near either end (a rupture in the middle requires Tommy John). Second, the ligament has substance and integrity (older pitchers may not meet this requirement). A hole is drilled in the bone, and swivel-lock brace is attached. The torn end of the existing ligament is attached to the brace by special sutures. Parallel to the ligament, Arthrex tape (which looks like a thick woven silver ribbon), is attached to braces to protect the ligament. It reduces the need to immobilize the joint, and allows earlier motion. The earlier motion supports faster recovery.

Although primary repair has been done on college pitchers, only three MLB pitchers have had primary repair. Two of the three pitchers are Seth Maness and Mitch Harris.

Seth Maness. For four years, Seth Maness was a relief pitcher for the Cardinals. He had primary repair surgery on 18 August 2016, and is expected to be ready by opening day, 2017. That is a 7.5 month recovery time.

Maness said, “You know anything in that area and automatically you want to avoid assuming any elbow pain is it. Because, oh man, it’s a career. Today, it’s not a career-ender, but really for a reliever it throws a little wrench into the scheme of things. I’m expendable. Things can happen.”

Mitch Harris. In 2016 spring training he was injured. His Instagram stated, “last week we determined that my UCL had come off of the bone in my forearm and there was a hinged bone spur as well.” He had primary repair surgery in June 2016. He wrote that he will be ready to pitch by Jan 2017, which is a 6-7 month recovery time.

In 2008, Mitch Harris graduated from the US Naval Academy, and was drafted by the Cardinals. While he served in the Persian Gulf on a Navy carrier, Mitch Harris kept his arm in shape by pitching on the flight deck to a cook. His first year in the Majors was 2015. I cheer for his success story!