For years, Tommy John surgery has been the safety net for pitchers with damaged elbows. But what happens when that safety net wears thin? Increasingly, pitchers are finding that the repaired ulnar collateral ligament (UCL) doesn’t hold up for as long as they’d like. Within four or five years, some of these pitchers are heading back under the knife for revision surgeries — an option, but one that offers lower success rates and more prolonged rehab.
The trend is troubling, and the pandemic only added complexity to the process. Take pitchers like Noah Syndergaard and James Paxton, who went through Tommy John in 2020-2021. Their post-op journey was anything but smooth. COVID restrictions limited rehab facility access, delayed physical check-ins, and, in many cases, slowed the overall recovery process. When something as vital as a daily rehab check-in is reduced to a virtual session, things inevitably slip through the cracks. It’s like trying to run a race with one shoe — possible, but you’re just not set up for success.
Then there are the new wave arms like Garrett Crochet, who went under the knife in June 2022. He’s not your typical Tommy John case: Crochet’s a left-handed flame-thrower topping 100 mph, with the Chicago White Sox already slotting him in high-leverage roles before injury struck. Crochet is cut from a similar mold as guys like Hunter Greene or Nathan Eovaldi — guys with immense power potential but a history of UCL vulnerability. His 100 mph fastball is electric, but could be a ticking clock.
For teams that are looking to trade for Crochet - and they are many - have to factor in whether or not they can re-sign him to a long term deal with the risk of missing a season or more in there, depending on timing of that potential injury, or whether they’re willing to pay for his upcoming two arbitration years and let him walk away after the ‘26 season. That’s two years of really getting to know the player, understanding the risks, and figuring out just how big you’re willing to go.
In the modern game, velocity is currency, and teams are cashing in. But with every uptick in speed comes added risk to the elbow. It’s simple physics: that joint wasn’t designed to handle repeated max-effort throws. A study on revision Tommy John surgeries showed a roughly 70 percent return-to-play rate — down from over 80 percent for first-timers. Revision is not just a “reset,” and the demands of post-repair elbows to keep firing at top speed might mean more of these high-velocity pitchers are on borrowed time.
Syndergaard’s 2021 season might as well be the case study for pandemic-era returns. He went from an all-star potential ace to a cautionary tale, even after a 14 month rehab. If there's one lesson there, it’s that the game’s current demands for hard-throwing arms often override caution. Those who want to push the envelope in recovery are often praised—until the elbow gives way again.
The reality is stark: every pitcher who goes under the knife is entering a cycle where, four or five years out, the risk of revision surgery becomes a looming specter. The game has to consider whether this is sustainable. For the Garrett Crochets and Hunter Greenes of the league, it might mean reconsidering the structure of rehab and finding ways to keep arms healthy for longer, instead of hoping that “fixing” a UCL will magically erase the risk.
We don’t yet know whether Internal Brace procedures will reduce this revision rate, though early data suggests they should. At lower levels, the revision rate is minuscule, but we’re dealing with much different bodies and forces. (The other promise of Internal Brace, lower rehab times, has not come through. Spencer Strider may be out as long as a standard TJ and this is something I’ll discuss more soon.)
The warning signs are flashing, and if the pandemic taught us anything, it’s that adding pressure without adequate preparation leads to breaking points. Today’s pitchers face higher risks than ever. If teams don’t adjust their handling of rehab and workload management, the four- or five-year revision cycle could become a common, unavoidable reality.
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When I discussed Roki Sasaki last week, I mentioned that he’d be expensive. That’s relatively speaking. As many pointed out, Sasaki will be in the same situation as Shohei Ohtani was in, being posted “early”. He’ll be subject to the bonus pool, which means he won’t officially be posted until mid-December so as to make the 2025 bonus pools, which come in January, replenish.
Remember that not all bonus pools are the same either, but that likely won’t be a big deal. Sasaki is going to pick a team, not a salary. He’ll get a raise just by coming to America and set himself up for the big Ohtani-type deal in six years. Even if he has what many consider an inevitable arm surgery along the way, that’s not going to keep him from being a top free agent come 2030.
While his agents have insisted publicly that no deal is done (read: Dodgers) and that every team will have a chance to sign him due to the limitations, there’s already clarity that it will be one of very few teams. Aside from the Dodgers, Sasaki is close with Yu Darvish, who could steer him to the Padres. Even with the Pads likely to have to offload some salary this off-season, Sasaki would fit in the gap where Joe Musgrove would go nicely.
Talking to people around the league, few have a real idea what AJ Preller can do to trim salary aside from dealing key players. Luis Arraez might fit somewhere else, as might Xander Bogaerts, but there’s little in ready replacement on the farm. If forced to trade either Dylan Cease or Michael King, Sasaki should fit in there as well.
Teams expect the Mariners, Giants, and Rangers to get consideration, while other teams will push to get Sasaki to at least think about it, even if they can’t push a bigger stack. Where it could get interesting is if teams can convinced Sasaki and his agents that there’s more outside opportunities. It won’t be as overt as putting Sasaki in the next Mario Party or pitching mutual funds, but it will be key.
If there’s one absolute outlier who could make an interesting case, it’s the Athletics. For at least the next two years, the team is without a home, but Sacramento is comfortably close to large Asian communities in the Bay (and travel home) and they are going to open in Vegas during his six years. Ohtani became huge in America even without winning and the A’s could offer him assurances on usage that other teams looking to win now might not. If Sasaki takes the long view, this one gets interesting.
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Brent Strom heading to the Pittsburgh Pirates? Strom and Skenes? Strom and the rest of the young arms they’ve collected? Ok, I’m suddenly very intrigued by this team as soon as next year, even with the Brewers remaining the Brewers and the Cubs spending money. The Cards are down, the Reds are unfocused, but the Pirates might be a player or two away (and convincing Bob Nutting to actually spend money) from being in the playoffs.
Seriously, the rotation could be Paul Skenes, Jared Jones, Bubba Chandler, Thomas Harrington, and Mitch Keller by midseason. Heck, I get to watch Chandler, Harrington, and Hunter Barco for the first part of the season in Indy. Imagine Pete Alonso and Skenes together for the next five seasons …
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The announcement that the Rays will play at Steinbrenner Field in 2025 isn’t a surprise, if you’ve been following along here. The need to keep advertisers and season ticket holders engaged ruled out almost everything else. The question now goes to 2026 and beyond. With the new stadium — what are we calling it for now before the inevitable corporate name? — not expected to be ready until 2028, putting $55m into renovating/repairing Tropicana might not make sense. Could that money be used to accelerate the build? Ha, I’ve been watching Grand Designs a lot lately and new builds seldom go smoothly or on schedule.
Which reminds me, Minute Maid Field in Houston is rumored to be changing. Daikin, an air conditioning company, is said to have a deal in place, though it hasn’t been officially announced. Another Japanese company coming into MLB is interesting, though I doubt it makes the Astros a real contender for someone like Sasaki. Daikin Field is going to sound a bit odd, but my issue with most new stadiums is that there’s no base name. People still think of Jacobs, Comiskey, and BOB, even though those names have been gone for years.
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I did another episode of Downstream with Jason Snell, which should be out sometime today (Thursday). We discussed a lot of sports and streaming, including a lot about Diamond and their new single game prices. At $7, it doesn’t make a lot of economic sense, though I guess there could be impulse purchases or late season key games where it does. However, I don’t think this will be the real price. I think we’ll see sponsors come in, especially gambling houses, willing to say “watch the game free with a $5 bet”. Heck, how many places would pay for it if you watch a commercial or even just sign up for a mailing list. CAC is a real thing.
Hey Will, great post. You don’t see the Mets as being a possible landing spot for Sasaki?