UTK Special 1/23/23

The Tommy John Turn

I started out writing this as a simple look at players who would be coming back from Tommy John surgery in the upcoming season, as it’s often a good place to find a little fantasy value. However, the changes coming in UCL repair and reconstruction are huge and we’re going to be hearing a lot more about it at next week’s ASMI Injuries in Baseball Course, which will be held in Frisco, Texas. I won’t be there, sadly, but have several people in attendance that will share what they learn.

The issue is that we’re starting to see a difference in surgical techniques. UCL repair, InternalBrace augmentation, and even more advanced techniques are being done, but we don’t yet know exactly when or what. That leaves a little more uncertainty with “Tommy John” comebacks, because in some cases, it’s something almost entirely different.

What we also aren’t seeing is the early promise of the augmented repair - speed. Repair rehabs are exceptionally conservative and matching, even exceeding a normal reconstruction rehab. Where early experiments brought back some athletes in what is likely too short a time - weeks, not months - the conservative rehabs are muting the gains. At lower levels, where athletes aren’t as controlled or guided, we’re seeing far faster returns.

You’ve likely seen some of the results from Dr. Chad Lavender’s work on ACLs, with patients running at eight weeks and going through full sport-specific workouts at four months. While Dr. Lavender is still being conservative with his returns, holding most out for six months, the sheer success of his procedure and the increase in the number of surgeons learning and performing the procedure is only going to accelerate the process.