Tommy John surgery (TJS), also known as Ulnar Collateral Ligament Reconstruction, is a fear more commonly associated with pitchers. It is so commonly seen in pitchers that the consistent recovery time means that pitchers coming off TJS can still secure very lucrative major league deals.
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Seeing a position player go under the knife feels so much more foreign. TJS does not feel like the same level of deathblow for a player whose most impact occurs with the bat. Even when Cubs prospect Cole Roederer had TJS earlier this year, the expectation would be that he’d be in a position to continue developing as a hitter sometime early next season. Roederer receives high marks for his defense. While he should continue to make strides there, his ultimate progression as a player is tied more directly to his ability to adapt to higher levels of pitching.
However, a catcher’s impact on the field is almost unparalleled. Not only do they manage a pitching staff, use their arm to control the running game, assist with defensive positioning, and worry about framing/blocking pitches, but they also have to hit. There are numerous intangibles involved in the position. Adding a surgery and rehab on top of a complicated development process feels cruel. That’s why this headline was a particular gut-check.
Citation: Camp CL, Conte S, D’Angelo J, Fealy SA. Following ulnar collateral ligament reconstruction, professional baseball position players return to play faster than pitchers, but catchers return less frequently. J Shoulder Elbow Surg. 2018;27(6):1078-1085. doi:10.1016/j.jse.2018.01.023
With that in mind, let us look at what TJS means for a player whose impact behind the plate is every bit as important as his work at the plate?
There is limited published research in position players who undergo TJS, but this 2018 paper was published in the Journal of Shoulder and Elbow Surgery by Dr. Christopher Camp and colleagues. Dr. Camp is the Minnesota Twins team physician.
Pertinent to this review, the authors found that of the 167 position players who had TJS from 1984 to 2015, 75.5% returned to play at some level of professional ball. On average, that return to play took 11 months.
The rate at which catchers returned to play was only 58.6%, significantly below infielders (78.6%) and outfielders (88.9%). Catchers also took approximately 12 months to return to play. Thankfully only approximately 5% of position players who undergo TJS need a second surgery. When they did, that most often occurred about two years after the first TJS.
UPDATE: It’s also worth considering whether TJS are significantly more effective now than they were when the surgery first began to be performed on position players in 1984. In a ten-year sample of TJS in catchers performed from 1/1/2010 to 12/1/2019, a total of 34 TJS were performed in catchers. In that sample, 31 out of the 34 (91.2%) TJS resulted in the player returning to play professional baseball. RTP dates came from the Tommy John Surgery database (referenced above) with players spot-checked in Baseball Reference.
The Rehab process:
After scouring articles, journals, and touching base with individuals who have been involved in the rehab process, the following is a basic overview of what a rehab from TJS for a position player may look like. Individual plans will look different. Disclaimer: none of this constitutes medical advice. It is solely to provide some background for readers.
Phase 1 (six weeks post-surgery): Immediately after surgery, the primary focus is rest and regaining wrist strength. A player wears a splint that immobilizes the elbow for approximately a week. Exercises often involve activities like squeezing a stress ball. After the splint comes off, a player wears a range of motion brace to build back the arm’s range of motion slowly.
Phase 2 (six weeks to three/four months post-surgery): Elbow strength becomes the primary focus during this phase. Increased focus on not just range of motion, but the function of that motion. This phase is still light in intensity and throwing a ball is not commonly done.
Phase 3 (after approximately three/four months): Hitters begin to hit and players begin a slow throwing program during this phase. As the player continues pain and injury-free, the activity ramps up in intensity to attempt to mirror game action. For example, later on in his recovery, Matt Wieters began to simulate innings by throwing a ball from behind the plate to the pitcher’s mound in 25 throw increments.
According to the Tommy John Surgery List data, Miguel Amaya will become just the 48th catcher who played professional baseball to have TJS. Let’s look at a few notable examples by evaluating caught stealing % (CS%), home runs, and OPS from the catcher’s last healthy season and first full season back. If the catcher came back midseason, CS% and OPS are provided for that season as well. Return to play time is listed in parenthesis and is based on first game the player was able to play including spring training:
Travis d’Arnaud (10.5 months)
Date of surgery: 4/17/2018
Date of return: 3/3/2019
2017: CS% 17%, home runs 16, OPS .735
2019: CS% 33%, home runs 16, OPS .745
Salvador Perez (17 months)
Date of surgery: 3/6/2019
Date of return: 7/24/2020
2018: CS% 48%, home runs 27, OPS .713
2020: CS% 48%, OPS .713
2021: CS% 44%, home runs 48, OPS .859
Christian Vázquez (11 months)
Date of surgery: 4/2/2015
Date of return: 3/8/2016
2014: CS% 52%, home runs 1, OPS .617
2016: CS% 35%, home runs 1, OPS .585
Individual recoveries can be vastly different amongst catchers. More experienced catchers like Salvador Perez likely had little to work on when it came to the intangibles at the position. Travis d’Arnaud and Christian Vazquez were just breaking into the league when they had TJS. For d’Arnaud, he recovered quickly, but Vázquez took an additional year to break out into a mainstay catcher.
Miguel Amaya was on the fast track to Chicago, and this reported surgery is a significant speed bump. History tells us there is a wide variety in catchers’ time to recover and adapt to the game. However, if you’re down on Miguel Amaya, it’s important to remember perhaps the most critical component in any recovery process: strong mental will. Cubs officials lauded Amaya for his intangible qualities. Hopefully, Amaya has the opportunity to make good on these in 2023 and beyond.
Featured photo of Miguel Amaya in Spring Training by Rich Biesterfeld (@biest22)