Under The Knife 5/3/24

All In Internal

A month into the season and yes, injuries are up. Derek Rhoads is working on a piece over at Baseball Prospectus so I won’t get ahead of that, but suffice it to say that the numbers are up across the board and frighteningly so for pitchers. The high percentage of pitchers on the IL include many coming back from injuries in past years due to the long rehab times, with some losing two full seasons to rehabs. Already too long, rehab times are actually trending longer.

Perhaps a year and a month of data isn’t enough to make any hard decision, but it’s very clear there was an injury uptick in 2023. It wasn’t low before, but for pitchers, it’s clear something changed … and yes, something changed. I can’t completely blame the pitch clock here, but it’s hard not to notice the timing either.

Like the uniforms, I’m sure MLB is hoping something will happen next year and that things will be different. It’s not going to be as easy as Nike using a thicker fabric, or is it? One insider whispered that MLB thinks that InternalBrace procedures might end up saving it from itself. “There’s a preprint on revision rates that’s something we could hang our hat on,” they said. To put that in English, there’s an early study that’s not fully vetted showing that repeat (second, third, etc) procedures are significantly down at the top levels when augmented procedures are used. That’s been known, but if MLB is going to push this - “Official Ligament Enhancer of MLB!” - it’s a positive, but does nothing to reduce the rates, especially at lower levels.

I’m certainly not against MLB pushing for more studies or even championing the use of a novel technique, one that’s show for over a decade that it has huge promise. It’s already been used on the game’s biggest stars - Mike Trout has it in his thumb, Shohei Ohtani and Tyler Glasnow in their elbows, and Ronald Acuna Jr in his knee. So if anything, why did it take so long? We’ll see how this plays out and what else can be done, especially if the injury patterns of the last few years keep the injuries coming all season long rather than front loading.

For now, let’s get to the injuries:

MIKE TROUT, OF LAA (torn meniscus)

By the time you read this, Mike Trout will have had his surgery. I debated waiting, but nothings going to really change and by Monday, we should have a real solid idea about when Trout could be back. The decision made in surgery - repair vs remove - is going to be the big one, with all indications that remove is the likely option.

You can go back and read Wednesday’s UTK for details on the knee, but nothing is going to change between then and the surgery. Why the delay? It’s likely simply scheduling, allowing a choice of doctor and for Trout and the Angels to have everything in place for his rehab to start immediately.

A key thing I discerned from multiple sources is that this didn’t come as a surprise or as an acute injury. Trout has been dealing with this for at least a week and it’s very clear in his numbers, especially if you dig into Statcast. Almost everything is down and watching his movement in the field is a pretty clear indication. Trying to manage someone through a knee issue like this is possible, even over the long term, so if this had been going on since the start of the season or even before, I wouldn’t be surprised. Even with his homers, it could be that Trout was simply making a typical adjustment and wanting to trot around the bases rather than running out doubles.

A reader asked what the long term consequences for removal are for Trout. This all depends on what “long term” means. Looking for comps brings up some big names. One scout I spoke with suggested Albert Pujols, but there’s no evidence of a talent fall-off from Trout. B-Ref says Duke Snider and I can see it, but Snider’s size is nothing like Trout’s and i think that counts here.

The one I keep coming back to is Chipper Jones, who played until he was 40, but has a noticeable drop-off after 32. He won a batting title and was a regular All-Star, but it’s still a drop-off that can’t be attributed to injuries. Jones missed an entire season (1994) with an ACL reconstruction, which was a much different procedure then. It didn’t slow him down, literally, and was never a major issue throughout his career. Trout’s physical issues happened earlier than Chipper’s downturn as well, but I look at the numbers and see a possible pattern.

If “long term” means playing another decade, the first issue is that there could be some arthritic changes. Trout is less likely to run as freely, so he could move from CF or even DH more. Down the line, these could get worse, where Dwyane Wade is the exemplar. Here’s a great article from peak B/R about what all Wade went through to continue playing at a high level. Will Trout - who has his own therapists already - be willing to do the same things?

Longer term - like 20 years or more down the line - Trout is more likely to have a knee replacement than the general public. However, Wade still hasn’t had one and seems to be living a pretty good life in retirement. I had my medial meniscus removed back in 1984 and never had major issues with it. I’ve had recent imaging and there’s no major arthritic changes, though I’m certainly not comparing myself physically to Trout. Concerns for “long term” are overblown here; Trout and the Angels are right to be concerned with the now and making it so he can play again, soon and longer term.

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