Under The Knife 2/12/24

Best Shape of Their Life

Welcome to the first standard* Under The Knife of 2024. This is going to be year 23 — the Ryne Sandberg year — of the column and season five here at Substack. This is the one you pay for and the rest is just a bonus. Under The Knife is the best injury info for MLB, no matter who you are - fan, fantasy player, gambler, someone’s mom. It hasn’t changed in this many years because … it works. I’ve learned more, my sources have gotten better and deeper, and I feel like I’m at the peak of my abilities as both a journalist and as an explainer/translator.

Everyone seems to want an origin story when we meet - “How did this start? How did you get into it?” - and it’s a fine story, but what’s much more important is the work. “Can you do this every day for twenty years?” or “Can you explain a sprained ankle for the millionth time without screaming like you are the one with the sprain?” There are times when I drag myself to the keyboard, but there’s never days I flat out don’t want to do it. Look back at just this Substack’s history (and subscribers can read all the older articles) - I don’t miss much. When I had my heart attack on a Monday, I filed my next story to B/R on Thursday.

I also respect your work and time. You pay five bucks a month - and yes, it’s five bucks again this year. I want to earn that payment with every column. I encourage monthly subscriptions because I don’t want anyone locked in. I have to earn your money every month, by giving you something you want. The line used to be “for the price of a Starbucks”, but you’d better not want an extra shot these days. Plus, the barista won’t tell you how well Clayton Kershaw will come back later this season.

For the free subscribers - the ones that get the emails, but can’t read past the paywall - I want to know what I have to do to get you to pay the five bucks? Is there anything? I get five bucks isn’t nothing, but it is the lowest amount Substack will allow me to charge and it hasn’t gone up the entire time I’ve been on this platform. I’m not getting rich here. I couldn’t make a living off what I make here and frankly, that’s fine. My goal is 1,000 paying customers and I think I can hit that this year.

Congrats to Patrick Mahomes - and anyone that read the chapter in The Science of Football that describe exactly how he trained for this moment, though I’ll admit I didn’t anticipate Taylor Swift… So, powered by some Liquid Death tea, let’s get on to the injuries:

SHOEHI OHTANI, DH LAD (sprained elbow/rehab)

We know Shohei Ohtani isn’t going to pitch this year - though I still have questions about that, most around what the actual surgery he had was. Since the start of this process, Ohtani’s people and Dr. Neal ElAttrache have all been rock solid on Ohtani being able to hit from day one. Reports that Ohtani is swinging now are positive, but also indicate it wasn’t the normal off-season and that he might be limited and “behind” a bit in the spring. The goal is Opening Day, so none of that matters and the support staff have likely all been focused on the goal.

I’ve seen several stories and posts asking why Ohtani is so far ahead of Bryce Harper’s schedule. The answer is that the surgery wasn’t the same. Probably. Again, we don’t know exactly what the procedure was, though we know Harper had a Tommy John Classic. (God we need better nomenclature.) We’ve seen some pretty amazing comebacks with augmented procedures, so seeing Ohtani at this stage at five-plus months isn’t quite as impressive as Audrey Biggs back in games at six months.

The best player in the game is only half that in 2024, but the signs are positive that he’ll be able to that more or less normally. ZIPS has Ohtani at 39 homers and within his normal slash range. ZIPS is a bit down from the STEAMER or BAT ranges, but every expectation also comes with a high at-bat count. Most systems take injury into account, but Ohtani tends to miss a few games a year and even a sprained elbow didn’t cause him to miss much. Looking at the stat lines, as projection engines do, wouldn’t notice it and I think that’s what we’re seeing. I see 2019 as the downside case. It was a different procedure with a longer recovery, but if ‘24 ends with Ohtani at 135 games played, I wouldn’t be too surprised.

Normally, this is where I’d drop the paywall. Free subscribers get one key player injury a day, but I have four more Dodgers alone, then three Rangers, and a handful more guys and Spring Training is just opening today. I hope this kind of info is worth subscribing and again, I’m asking you to consider it.

WALKER BUEHLER, SP LAD (sprained elbow/rehab)

Walker Buehler didn’t come back last year and I still haven’t heard a really good explanation on why. Yes, Tommy John rehabs are longer, but I remain unconvinced they need to be. I’m not blaming Buehler here; the calendar worked against him, but there was such confidence and optimism in late summer, plus a hope that Buehler could come back and help the club in the playoffs.

At worst, Buehler has had more time to recover, build up, and come into the season. However, all indications are that the Dodgers will limit his innings somehow. This is another thing I don’t get. At this stage, his elbow is healed. He’s had a full off-season to build up. Monitor his fatigue and workload, yes, but why flat out limit it with artificial numbers that have little basis in the science?

How far Buehler can go, both in games and into the season, will determine just how deep this staff really is. If Kershaw comes back mid-season-ish, he and Buehler should amount to about 200 innings under the Dodgers’ public plan and with two young arms who will need to do 300 between them, an injury to any of the top guys puts the Dodgers rotation back where they were last year - forced into moves they don’t really want to make.

CLAYTON KERSHAW, SP LAD (strained shoulder/rehab)

It was no surprise that Clayton Kershaw re-signed with the Dodgers. The second year option is the more interesting one to me. The more I talk to people, the more I think the marketing staff had as much to do with this as the baseball folks. Kershaw and Ohtani in the same rotation - to say nothing about Tyler Glasnow and YY - is a ticket sales dream, especially on the road. The option is a big carrot to get Kershaw back one more time.

To get there, he has to get back and while I’m beginning to get more confidence about it, there’s still something around a 50/50 chance that we’ve seen the last of Kershaw and more like 80 percent that he’s not going to be good enough to hold the rotation slot. I did have an interesting discussion with a baseball ops guy from another team wondering if Kershaw could be an effective late inning guy if he still has that curveball. I’m not even hazarding a guess there, since it would depend on his ability to warm up and recover on a different schedule. A late-career Smoltz? Maybe.

What I’m curious to see early is what Kershaw’s doing. He’s throwing, but how much and how far? It’s hard to get a good look at that sometimes, but I have enough eyes inside that I think by the time we get to March, both the Dodgers and I will have a very good idea about the when and the if, which means you will as well. (For five bucks a month, that is.)

DUSTIN MAY, SP LAD (sprained elbow/rehab)

Dustin May had Tommy John and flexor tendon surgery in July, but the Dodgers are still saying mid-season for him. Why the optimistic timeline for him and not for others? The first answer, again, is we don’t know exactly the surgery he had. The second is May’s status. He signed to a relatively small deal this season, knowing he’s injured, but he’ll be a last year arbitration guy next year. If he comes back and pitches well, he’s an asset, but one that gets more expensive on an already expensive team. If he doesn’t he’s a non-tender that gets a one-year show-me contract ahead of free agency.

May has basically a full year of starts in his career - 34 - and they’ve been largely good ones. The quick revision of his Tommy John is unusual, but even though he throws hard, before and after the first elbow surgery, there’s no reason to think he won’t after the second. Plenty of guys throw hard these days and plenty - a third - end up like May, with a scar on their elbow. So why did he have such a quick re-injury? That one’s tied up in the biomechanics and things we simply can’t know from out here.

2025 is a far different issue for Dodgers pitching depth, at least in theory. For a team that should have more depth in the second half and a known timeline on Ohtani, who could conceivably be their fifth starter at that stage, May is one of the unknowns for the path forward and potentially the first casualty of the team’s spending this off-season.

GAVIN LUX, SS LAD (sprained knee/rehab)

At least this one isn’t a pitcher. Gavin Lux went out in spring of last year and had his ACL reconstructed. The timeline is very positive. He wasn’t likely to make it back last year without rushing it, though he had a standard reconstruction. At almost a year out, he should be 100 percent physically, though he’ll still likely need to get a bit of confidence in the knee. That can come quickly.

He should already be doing all activities and likely had about as close to a regular off-season as possible. As far as what he can and can’t do, it’s going to very binary. He should be physically ready, so if there are remaining deficits by the mid-point of the spring, things get interesting. I’m looking for range, quick first steps, and no hesitation at the kind of first-to-third run that last time out ended with him heading for surgery. My guess is we’ll forget all about the knee by the time we get to April.

Having Lux as the full time shortstop helps, in that in theory he should be helped by the stability, but while Dave Roberts’ roster still shows some flexibility, I’m not sure it’s ideal. Mookie Betts at short and Lux at second would seem to have less lateral stress on Lux, but I’m sure they have data or some physical reason to go here. The roster can still mix and match as needed, it just shouldn’t have to as much in it’s current state.

COREY SEAGER, SS TEX (sports hernia)

The question when Corey Seager had his sports hernia surgery was “why did he wait so long?” The answer is pretty simple. For this kind of situation, a player wants to try and avoid surgery. The recovery period for this is very well established, so there’s a “line in the sand” - a date where the decision has to be made. Seager got to that date, the issue hadn’t resolved, and he’ll be back in spring training enough to have a near 100 percent chance of being ready for Opening Day. Will he be a bit behind? Yes, but Seager’s not someone fighting for a position.

Even “he needs reps” is becoming something that’s easily correctible through compression. At bats off the Trajekt might not be the same thing as spring training at bats, but I’m not sure how much off they are. Seager might get two at-bats a game off a quality major leaguer in a spring game. He might get twenty in the tunnel. Sure, both is better, but this is something where the rules have changed.

The sports hernia issue is now fixed and Seager should have no issues after about a month. It’s amazing this was a major issue and about twenty years ago, a new type of procedure made this about as simple and correctible as any injury. The diagnosis and term didn’t even really exist until the late 1990’s. Things move fast around here.

MAX SCHERZER, SP TEX (inflamed back/rehab)

Max Scherzer had back surgery, but again, we don’t know exactly what. The timeframe screams fusion, especially given the chronic nature of this, but it could also be a microdiscectomy. Someone go check his scars, please. Failing that, we have to wait and see, though with workouts starting, that seems like the early stage medical rehab - what you and I would do after a similar procedure - went well and he’s upping it to things a professional athlete would do, focused on the specific demands.

For Scherzer, it’s going to come down to when he can twist and bend. He’s always had a strong core and an analytical bent, so I don’t think adjusting some will be an issue. It does tell us the “back spasms” that knocked him out of the World Series were more serious and that the Rangers likely knew this at the time, but then again, those “other procedures” - things like nerve blocks and other conservative therapies - suggest they thought surgery might be avoided, until it couldn’t be.

As with Kershaw, the question is how he’ll do when he comes back. If it’s a fusion, there could be some biomechanical issues he’ll have to adjust to. Again, watching him in camp will be a guide even if he’s months out. The Rangers themselves haven’t been aggressive at filling in their rotation. With Jordan Montgomery likely not re-signing, the Rangers have three pitchers who won’t pitch at all until the second half and almost no depth behind what they have. A single injury would be problematic with the current state of the rotation. Does the Rangers front office know something we don’t? Surely so, but that assessment has to be right.

JACOB DEGROM, SP TEX (sprained elbow/rehab)

As complicated as some want to make things with Jacob deGrom, his return from Tommy John surgery really is simple. He’s on a standard time frame, despite a near certainty that he had an InternalBrace procedure. Maybe coming back at around a year is a bit better than standard, but the timelines for lower-level augmented repairs have gone down much more. We haven’t even had a Fertilized UCL (or as Arthrex is calling it, “BioACL” for Chad Lavender’s procedure. See the Biggs video above.)

DeGrom’s timeline should have him back somewhere in the second half, but there’s no reason for the Rangers to really clarify that. What we see deGrom doing in the spring will be telling, but that’s information that’s known. As with Scherzer, the fact that the Rangers were willing to let Montgomery go says something about what they see in their rotation. That could well be a positive view on deGrom’s return.

FELIX BAUTISTA, RP BAL (sprained elbow/inflamed elbow/rehab)

Felix Bautista underwent a second elbow surgery. He had a bone spur shaved down and his ulnar nerve transposed. Both are very common, to the point that the nerve transposition happened to Tommy John himself. It really adds no time to the recovery and slows the rehab only slightly. While Bautista is unlikely to return this year anyway, this changes nothing about the theoretical late year possibility or his future potential.

Those of you that are surgeons, please don’t flood the inbox with discussions of debates about bone spurs or transposing the nerve during the reconstruction. Those are debates that have gone on for thirty years and are differences in technique. There’s plenty of studies out there if any others are more interested in the technicalities. I’m interested in when Bautista can come back and whether Craig Kimbrel can be an effective one-year fill-in.

GERMAN MARQUEZ, COL SP (sprained elbow/rehab)

The Rockies need all the help they can get. In what should be a great market, they’ve spun their wheels for a decade. It used to be that the franchise got away with the fact that they couldn’t figure out the altitude question. Now, they’re not even looking for answers, pointing the humidor with the zeal of an overnight Taco Bell employee at daybreak.

They will get their ace back, though Marquez might be the four on some non-contenders. Prior to the elbow injury, he was very durable, but remember when someone tells you “this pitcher is different”, they’re wrong. He should get back to that, and retains some upside, but that upside is slightly better than 500 and an ERA somewhere in the 4’s.

I don’t mean to be this down on Marquez, but the franchise has just done utterly nothing and any player on it is dragged down by the team’s complete lack of effort. They’ll occasionally spend money, but I can’t remember the last free agent that works. They’ll bring in projects like Dakota Hudson, but I can’t remember the last one that worked. They’re loyal to a fault, keeping players well past the sell-by date. I’m at least intrigued by the idea of a young Ezequiel Tovar-Brenton Doyle led team, but there’s just not enough young prospects coming to think that will happen.

Oh yeah, Marquez. He’ll be back around mid-season and the Rockies do tend to be relatively aggressive with their rehab timelines, and have had success with it.

Some ask why I have the “/rehab” tag in the diagnosis part of the tag. Some of it is how it gets transferred to my database, but most of it is a philosophical thing for me. A player like Ohtani or deGrom had a sprained elbow, which is why they had surgery. The surgery fixed it and the elbow is no longer sprained. Instead, it is healing. “Rehab” seems a better tag to me than “healing” or others, but when someone says “deGrom will miss the start of the season with Tommy John” or even “with a sprained elbow”, the pedantic part of my brain screams “he doesn’t have a sprained elbow! He doesn’t even have a ligament there just yet to be sprained!” Hence, the tag.

QUICK CUTS:

I don’t know why the Phillies have already ruled out Andrew Painter, who had July Tommy John surgery. He’s young, but not pitching for functionally two years isn’t great … No specifics on the knee surgery for Brandon Marsh, but the four week timeline points to a meniscectomy. He should have plenty of time to return, but the Phillies OF depth is a bit down … Some are starting to suggest that Blake Snell might take a one-year, high-value contract and hit the market again next year. That’s never been a Boras move, but this is a very odd market … Yes, I wrote a significant portion of this column on the Vision Pro. I was using it as a virtual monitor and it works amazingly well. Friend of UTK Jason Snell had a great review up on his must-read site that largely echoed mine, so I feel smarter.

*So far, there’s five “titles” inside the Under The Knife Substack. The standard is Under The Knife, as above. UTK Special is pretty much everything else - longer stories inside sports med or sports science, or sourced info from around the league. UTK Flash is just that, quick hitting, news breaking stuff that can’t wait for the next newsletter. UTK Off The Rails is the way out stuff, like last week’s review of the Apple Vision Pro or my annual music review. It’s mostly for quick-look ability to see what just hit your inbox or for searching. Speaking of searching, Substack has gotten better with search (but not better at punching Nazis.) On the home page, you can enter the name of a player and it pops up every column that that name is in. It works pretty well, though I’d love for it to pull things out and organize it player by player. I’ve been toying with an AI tool that could do that, but it’s not working well enough yet.