Under The Knife 9/17/21

Free Friday: Getting Ready for the Fall

One of the things that surprises people is that I don’t have a lot of data. People out there are doing the hard work, collecting days lost, dollars lost, making cool charts, and figuring out ways to make it work across sports. Jon Roegele has put together an amazing list of Tommy John surgery that’s an absolute godsend. Derek Rhoads is making fantastic charts. The crew at Man Games Lost is doing it in the four major sports, even hockey.

There’s no Retrosheet for injuries. Go ahead, try and find DL data for 1998. There’s a book I have on the shelf, the old “Red Book” that MLB had put together each year by it’s insurance broker. They stopped because they didn’t like what they saw (and it leaked that it existed.) I can see what Babe Ruth did on a rainy Thursday in 1922, but I can’t find a good source to tell me why Gary Gentry missed time in 1969 or even how Tony Saunders got hurt in 1999. (You have to search around and hope you don’t hit a gruesome video.)

Next week, I’m going to show you some of the worst injury numbers we’ve ever seen and why this is costing teams billions. Stan Conte’s 2016 study showed that MLB loses about $500 million a year, or $7 billion over his 18 year study, and it’s not getting better. Some fans of big teams are not going to like what they see and owners? Well, we’ll see what they think of not only a dollar loss, but a value loss.

You’ll see more of that next week and in a series of three, I’m going to make each of them free a day after you get them. I think that’s good value for you and I feel like this is something that needs to be seen by more people, even if they’re not cool enough to subscribe. Now, let’s get to the injuries:

Shohei Ohtani SP/OF LAA (inflamed elbow)

Shohei Ohtani has been everything the Angels expected and more in 2021, but ending with an injury might take a bit of the shine off what’s likely to be an MVP season. Part of that case is that he hits and pitches at a high level, something we haven’t seen in a century as more than a gimmick. The downside is he’s only going to do one of those the rest of ‘21 and the Angels are going to have to make a decision about whether they want him doing both in the future.

Ohtani was doing his side work, playing catch at a normal intensity when he felt tightness in his forearm. It’s enough that he’ll have imaging done and there’s a likelihood that he won’t pitch again this season. Joe Maddon hinted as much, but also hinted that he’d stay in the lineup as a hitter. That’s a problem if true, because that would say that it wasn’t a forearm issue. Hitters use their forearms in the hitting motion, but there’s very little stress on the UCL.

Does that mean Ohtani is having issues with his once-repaired UCL? That’s unlikely, given he’s still in the “honeymoon period”. Absent a major complicating factor, almost all pitchers have no issues with a reconstructed UCL during the first four to five years. The theory is that the time matches with ligamentization, a cellular process that physically changes the transplanted tendon into ligament. This happens even with cadaver tissue, which is pretty amazing and something very poorly understood.

Ohtani not pitching isn’t going to change where the Angels end up, but if this is a recurrent elbow issue, the Angels are going to have to ask themselves if they’re willing to risk his bat for what he brings. Given their rotation, losing an ace would be a big hit to their future plans. We’ll have to see how this team fills out around him, but the Angels just got a bit twist in what should be a plan that builds around the two best players in the game.

Mike Trout OF LAA (strained calf)
Jo Adell OF LAA (strained abdominal)

Even Mike Trout seemed confused by why his calf strain won’t heal. While he’s not answering on-the-record questions about his injury, there’s rumblings behind the scenes that there’s more going on than a simple strain. Living in Indianapolis has me wondering if Trout is dealing with something like Andrew Luck’s situation, but I have no evidence for that - just tossing it out there since it was a similar lingering calf issue. The bigger question is whether Trout will be able to clear this up working with his own people this offseason or if the Angels will want to stay hands-on with their star. My expectation is this will be Trout’s call.

Joe Maddon got called out on his update of Jo Adell’s condition after he said Adell wouldn’t go on the DL, then he did. Nothing changed - he had an abdominal strain after hitting the wall and it was serious enough to IL him - and it appears Maddon’s credibility with the local media is down where the Angels are in the standings. The team is in need of a complete refresh and firing Maddon is definitely on the table. It would surprise me and many I spoke with think he’ll get one more year.

“His pitching coach got fired so the season got off on the wrong foot. Maddon won’t get dinged too much for that, but he’ll be on the hot seat and likely won’t get much say in who does take over the pitching,” said one rival AL exec. I’m told that the Angels have been looking hard at pitching coaches and hope to have someone in place early in the off-season. Given their draft, I would not be surprised at all to see a college coach with a development focus get a shot here. Texas (Austin) coach Sean Allen is getting a lot of buzz.

Alex Wood SP SFG (COVID)
Johnny Cueto SP SFG (strained forearm)

The Giants are in a battle to avoid the coin flip game and while it’s not true that the team has gotten here with smoke and mirrors, they have done it with unexpected players. Another key has been depth, so the injuries and situations they’ve had to deal with have been covered by other players. It’s a pretty nice fit to this team and it’s held together creatively across the season.

Getting their rotation settled is tougher given the fight, but with each game counting, getting Johnny Cueto and Alex Wood back does nothing but help. This rotation isn’t going to match up with most playoff teams, so they’ll have to do what they’ve done all season, which is play to their strengths, not give up big innings and not make mistakes.

Wood is expected to pitch Saturday after a sim game this week went well. He isn’t showing any major issues after COVID, but he will likely be limited in terms of how deep he goes. Cueto is further off, but he’s at least throwing, so there’s a chance he could be ready. How deep he could go is a question, but he could end up a swingman who could follow Wood or really any of the starters in this modified four-man they’ve shifted to in September by need.

I’m actually more worried about the pen, which has been extended several times over the season. They’ve rotated through a bunch of guys who seem almost interchangeable. It seems like the Giants have figured out the three-batter rule better than most, breaking away from the Royals model of 7-8-9 power guys

Chris Bassitt SP OAK (facial fractures)

I always worry that so far, pitchers haven’t faced a big consequence for getting hit. We haven’t seen a move toward more protection, softball-style facemarks, or body protection that would keep something like the Joe Ryan comebacker from being an issue. The fact is, pitchers getting hit is a rare event with painful, but often transient consequences. Things like Chris Bassitt coming back are great, but things like Tyler Zombo still being in the hospital months after his injury are the worry, especially when those fade from memory because it happened in the minors.

That’s not to take anything away from Bassitt or the A’s medical staff. I’m very glad he got the quick care and that things have gone well in his rehab. He’s throwing off a mound and will throw a sim game over the weekend. The results of that will determine next steps, which could include a start later next week or time in the minors, but there’s every chance that Bassitt could give the team a bit of a boost as they try to stay in the Wild Card hunt.

Quick Cuts:

Jake Odorizzi doesn’t have a Lisfranc, but his mid foot strain is going to be problematic at this point in the season. Almost no chance he can build back to a starter’s workload even if the Astros make a deep run … The Astros haven’t given details on exactly what’s wrong with Michael Brantley’s knee, but the IL move does push a return back by at least a few days. It’s unclear if he’ll be ready early next week or what limitations he might have but being forced to DH really scrambles things if necessary … On the good news side for the Astros, Framber Valdez will be back Monday after having his start delayed due to a finger cut … Nelson Cruz took a pitch off his forearm. It will be sore and bruised but shouldn’t be a major issue. The Rays can be conservative given their lead … Wander Franco is taking grounders and doing some running. If his IL stint goes beyond the Tuesday minimum, I wouldn’t worry. There’s no need to push for the Rays … Shane McClanahan will be activated and start on Sunday. Expect a bit of a limit on him, but he hasn’t been out so long to demand a big cut … JT Realmuto took a nasty pitch off his upper arm. X-rays were negative but the Phillies, who are being intentionally quiet about injuries this season to no advantage, seemed concerned he’ll miss some time … Dakota Hudson made another rehab start, but could be back for the Cardinals doubleheader on the 24th … Sorry Mets fans hoping for a big name, it looks like Sandy Alderson is tipping his hand on who the next GM will be and its a doozie … Wade Davis is going to be shut down, likely ending his season for the Royals. His season has been very mixed so at 36 and a free agent, this could be the end … Blake Snell hits the IL with his groin strain, which likely ends his season. The Padres signed Vince Velazquez, just dropped by the Phillies, and he’ll start this weekend. That’s how rough it’s gotten for the Padres - their Triple-A team has seven pitchers of its own on the IL … Jesse Winker was supposed to have one more game in Louisville, but word is he made the decision to come back a day early. Very interesting … Have a great weekend - big stuff coming in the next couple weeks!