Under The Knife 9/22/23

A Manfred's Work

You don’t have to like Rob Manfred, but you have to acknowledge he’s had a good year. His rule changes worked and didn’t disrupt the game so much that people started questioning the stats. He’s solidified the position of baseball despite a crumbling broadcast partner, an injury epidemic, and an unexpected outbreak of Messi Fever in America.

Still, I think his best work is in Oakland and St. Pete. The second cities across their respective bays are getting entirely different looks at the Commissioner, as he exited the A’s and helped push the Rays into a long-sought stadium deal. There’s imperfections with both deals and the A’s have to lock in the Vegas deal or end up an even bigger problem, but I’m told Manfred and his team are focused on that and want to have everything in place before the Winter Meetings. We’ll see.

Stu Sternberg gets a new stadium, which everyone acknowledged he needed, but the push to lock this in shows just how much pressure was on the Rays and on MLB. It’s in virtually the same location, meaning the idea that people won’t come from Tampa or Sarasota remains in play. It’s small - 30,000, though it should accommodate what the Rays normally get, but limits the gate and the usefulness. Will concerts, football games, and physically larger events still be able to use the new park as they did the ThunderDome? (Oh did you forget the other names?)

In addition, Sternberg acknowledged he’ll bring in “investors” to help pay for the Rays portion of the $1.2b cost. Give him points for not asking for an Oklahoma City deal, but investors likely means new ownership rather than debt. The Rays had already talked with the Doyle family, owners of the locally based Dex Imaging. I imagine there are more, including some rumors of Penske involvement. Roger Penske, of course is known for his racing team, which opens its season just south of the Rays park every February. Expanding that as F1 comes to Vegas might be an interesting take, while Roger’s son Jay owns magazines and newspapers, like Variety, and brings his own possibilities. (Tampa Bay Ray-cing, anyone?)

With Oakland and Tampa’s decades-long stadium search theoretically over, the door to expansion opens. I’ve written on this elsewhere, but there’s enough interest that the places that want baseball will have to bid for it. Unless Oakland gets all lawyered up, which means we could end up with an Oakland sequel, a la Charlotte(NBA) and Cleveland(NFL). There’s complications will all the possibilities, but the checks attached will have three commas, which will be another pile of cash that Manfred delivered to his bosses.

I’m all for more places getting baseball and feel bad for how Oakland’s been a pawn. I’m stunned with how serious Salt Lake City has been, making them a leader as the process opens, and excited about the possibility of real realignment going along with the expansion. All of that is because of the work Manfred has done and I’m a guy who’ll always give credit where credit is due. After that, maybe MLB can get serious about injuries, but until then, let’s get to it:

SHOHEI OHTANI, SP/DH LAA (sprained elbow)

Well, I thought we were done with the Shohei Ohtani saga, but we’re not. At least I’m not. Credible sources insist that the confounding “added viable tissue” means that a new graft was placed. However, the same statement from Dr. Neal ElAttrache references “healthy tissue in place.” The assumption I have is that the sprain was low-grade, given the normal standards for braced repair versus a more standard Tommy John.* If it were not for the “healthy tissue” phrasing, I’d think this might be a Tommy John with an InternalBrace, which has been done on some pitchers, most notably Tyler Glasnow.

If Ohtani had a reconstruction, then the timeline comes into question. Think of Ohtani only as a hitter and that the models for Bryce Harper (reconstruction) and Trevor Story (repair and brace) are reasonable timelines. With ElAttrache strongly saying** that Ohtani should be ready for Opening Day, that is far ahead of the Harper timeline. In ElAttrache’s own technique, shown in this video, you can see how the in-place ligament*** is handled.

It’s one or the other. If Ohtani is coming back on Opening Day, it’s extremely unlikely there was a reconstruction. If he didn’t have a reconstruction, the “added viable tissue” is a question mark. Unless Nez Balelo decides to give us more information, we’ll have to wait until free agency hits and the inevitable leak comes. Even then, this is so technical that I think the timeline is going to be really the only thing anyone cares about, and I can’t disagree with that at all. Then again, you do subscribe to a newsletter about baseball injuries, and I’m one of the few that care, so I’ll keep writing about it as needed.

Thinking about this more, the term “repair” is easily misconstrued. It can be an actual repair of the ligament, or fixing the problem. “I got my car fixed” or “I got my dog fixed” have two way different meanings. Then again, the word I don’t see here is “revision” and if it’s reconstruction, it’s the second and looking back at comments from ElAttrache and others, revision is almost always noted.

There’s one other suggestion I had from a source and that’s that the surgery, whatever it was, isn’t the key to the timeline. This source thinks that the rehab is the key and that ElAttrache feels like he can be aggressive enough with that to get him back. My take on that is that Bryce Harper would have had all the same options last year and didn’t come back until May. His surgery was slightly later, but does that month get Ohtani back on Opening Day? Does a rehab technique like blood flow restriction get him back a couple weeks quicker, putting that timeline in play? Again, I simply don’t know yet.

Ohtani is The Unicorn, a baseball impossibility, so I guess it’s fitting that he gets his own unique and inscrutable surgery as well.

(Jeff Fletcher has a nice article with some great quotes in here. While I still can’t say I’m sure of what was done, Jeff’s article pushes towards an answer. That’s good reporting.)

*I use the term “standard Tommy John” to denote a reconstruction of the UCL. There’s a number of techniques, including one developed by Dr. ElAttrache and Dr. David Altchek called “DANE docking.” DANE is the doctors’ initials.

**No, I don’t think that ElAttrache would let an agent tailor his statement in any way.

***Yes, Ohtani had a Tommy John reconstruction in 2018, presumably using ElAttrache’s standard technique. The tendon graft is still in place and has likely fully ligamentized, so “in-place” is correct.

CARLOS CORREA, SS MIN (plantar fasciitis)

Here’s what an eight game lead gets you: the ability to IL/bench a player ahead of the playoffs to get treatment and hopefully be as healthy as possible, managed by a solid medical staff that’s managed the player through the injury for much of the season. That’s what the Twins are doing with Carlos Correa, in the hopes that his plantar fasciitis is manageable, or at least managed for the next month.