to anesthetize the way that you feel

surgery is a big deal. surgery is the last resort. surgery is the defcon 1 of medical intervention.

it is a testament to both the extent of humanity's medical achievement and the ability of the human mind to adapt to pretty much anything it is told to believe that one person can now tell another, "i am going to take a knife and cut a big hole in you, cut out some parts that are broken, and then i'm going to sew in some new bits that i found on this other part of you, and we'll see if that fixes things, okay?"

and generally, the listener does not punch the speaker in the face, run away screaming, or have the speaker put on trial for witchcraft. which, not very long ago, might have been the most likely responses.

tommy john surgery has become so commonplace in the majors that it's almost viewed as a rite of passage. kyle mcclellan, jaime garcia, and jake westbrook all shared stories with adam wainwright this week to let him know what was coming and what to expect. chris carpenter has undergone the surgery as well, and probably provided his own expletive-laced narrative of the surgery and recovery process to adam.

and while there have been pitchers who have not recovered well after TJ surgery (kris benson, mike hampton, pat hentgen, darren dreifort, phil humber), others who had a brief post-surgery hurrah and then faded (BJ ryan, kerry wood), and still others who needed a further surgery (eric gagne), most recent TJ surgery has been successful. some of the best pitchers in the league have been successful after TJ surgery - tim hudson, chris carpenter, josh johnson, john smoltz, billy wagner, mariano rivera, and joakim soria.

one study indicates that more than 70% of pitchers return from TJ surgery to pitch at the same level as before. now, that article is 15 years old, and you may note that a lot of those failure stories happened ten years or more ago. i do not know whether the surgery has gotten substantially more effective than even the 70% mark described. a more recent study of athletes generally - rather than ball players -- found a 93% success rate. that may be due to improved surgery outcomes generally. it may also be due to the fact that throwing a baseball at 90 mph or faster is about the most stressful thing you can do to a newly-repaired ulnar collateral ligament and thus a survey of baseball player is going to yield more pessimistic results than one of athletes generally. however, a study done just two years ago appears to credit improved surgical technique for improved outcomes, and suggests that an 85-90% success rate is pretty typical with the newest techniques.

just try not to think too hard about phrases like the "muscle-splitting approach to the flexor-pronator mass."

now, having a 10-15% chance of not coming back well from surgery is nothing to sneeze at. that's still a pretty serious risk. if someone told you you had a 10-15% chance of needing to find a new job in the next year, in a new field, you'd be on edge. but, given the seriousness of surgery in the first place, those odds are pretty good.

but what do the numbers tell us? let's take a look at three recent guys to undergo the surgery.

jake westbrook, as a good in-house exemplar, had surgery in 2008 after several trips to the DL that ate up parts of his 2007 and most of his 2008 season. he had FIP's of 3.96, 3.88, and 4.33 in 2005, 2006, and his mostly-season in 2007, respectively. he was 30 at the time of his surgery in june 2008. he missed the remainder of the 2008 season and basically all of 2009, making only a 9 inning rehab appearance in the minors that year. however, in 2010, he put together a decent season on par with his earlier performance, yielding a 4.22 FIP. we'll be watching him this year, not just as a cardinal, but as a potential harbinger of things to come for adam.

josh johnson had TJ surgery in august 2007, after a fine rookie season in 2006 when he pitched for a 3.99 FIP. he recovered quickly and rejoined the marlins in mid-2008, posting a 3.37 FIP in 80+ innings that season, as well as a 3.06 FIP in 2009 and a 2.41 in 2010. both in terms of recovery time and ultimate results, johnson is obviously one of the TJ success stories. johnson, however, was only 23 when he had the surgery, which may have played a role in his quick, successful recovery.

tim hudson had TJ surgery in august of 2008, after posting FIPs of 4.55, 3.46, and 3.83 in 2006, 2007, and most of 2008. he was 33 at the time of surgery. he was out for about a year, coming back in late 2009 to pitch 40 innings for a 3.83 FIP, then a full season in 2010 at a 4.09 FIP.

at least in this abbrieviated exercise, i am having a hard time finding any meaningful effect of the surgery on the production of the pitchers who return from TJ surgery once they return. both hudson and westbrook have put up pretty similar numbers in their early returns (westbrook's split season numbers between cleveland - FIP 4.64 - and st. louis - 3.52 - may represent some improved late season performance as his recovery continued, the ease of pitching in the NL over the AL, or just sample size dumb luck). johnson's numbers have gone from good to jaw-dropping. 

you also can't look at the numbers in isolation from their appropriate aging curves - we would have expected some drop off from westbrook and hudson, even without surgery in that time, and johnson would still be rising towards his peak (which he is just NOW getting to).

the only other thing worth noting is the spread in recovery times. johnson's < 12 month recovery time is about as good as a prognosis could be. adam is hitting 30 this summer, so i wouldn't wager on him reporting with pitchers and catchers ready to go in 2012. however, i am actually fairly reassured that we will see him, if not on opening day, well before the all-star break and in top form. hudson, who was far older at the time of his surgery, pitched his first major league game after his august 2008 surgery on september 1, 2009, not even 13 months after surgery (he won, in case you wondered, going 5 and 1/3 innings, allowing two runs). westbrook would represent the cautionary tale of a longer TJ recovery time.

anyway, this exercise made me feel somewhat better, and i hope it did so for you.

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