Roughly twenty percent of pitchers who undergo Tommy John surgery never make it back to the majors. Most of those pitchers lack the track record of Jason Motte, but one in five pitchers failing to recover is an indication that Tommy John surgery is far from a sure thing. There are setbacks, injuries to other parts of the arm, and repeat surgeries that prevent pitchers from returning to form. The Cardinals have been relatively lucky the past few years. Since Jaime Garcia underwent the procedure nearly six years ago, 120 pitchers in the majors have had Tommy John surgery. Among those, just two were Cardinals. The first, Adam Wainwright, has had the best case scenario in his return to this point. The other, Jason Motte, just finished his own recovery process, ready to help the Cardinals' bullpen as they look to win another division title.
Motte is back, but questions about his velocity and effectiveness will remain until he has proven himself once again against hitters at the top level. In his post on Motte's return, Aaron noted that Motte had not yet returned to his peak velocity of 97 miles per hour and was sitting in the 94-95 range. At the game last night, his fastball averaged 93.4 according to Brooks Baseball. He also mentioned that given Motte's advancing age, this is not unusual, regardless of surgery. In his study on Tommy John surgery, Jon Roegale, used a chart to show relief pitcher velocity decline over time.
Studies over the past few years have reached differing conclusions on whether pitcher performance and velocity changes after undergoing Tommy John surgery. A recent summation of four studies provides a decent recap of some of those efforts. Studies are wrought with complications. Arguing pitcher value is a topic often argued within baseball. As the article linked noted, taking those values and attempting to tie them with medical success and failure can cause even more problems.
Another issue is how to gauge performance prior to surgery. Pitchers may be breaking down which is what caused them to need surgery in the first place. Using the statistics of an already injured pitcher and then comparing those to a healthy one after surgery and claiming improvement from the pitcher pre-surgery can be somewhat misleading. We want to know whether the pitcher can return to his pre-injured, effective performance, not whether he is better than the performance that raised injury flags in the first place.
Some studies use data going all the way back to Tommy John's initial surgery, which could cause differences in data given the surgery was originally experimental and uncommon compared to the number of surgeries over the past decade. One of the better studies (abstract here, brief discussion here) conducted by University of Chicago orthopedic surgeon Martin Leland, found no significant difference in velocity and performance before and after surgery. The study checks off many positive boxes. While Pitch f/x data is not perfect, using velocity in this manner as opposed to pitcher wins or other statistics highly dependent on teammates, park, etc. is more desirable. As a result, he dealt with a smaller sample size, just 41 pitchers from 2008-2010, but he also only selected pitchers with at least a year of data preceding surgery and two years of data afterward. He also used an uninjured similar pitcher as a control so as not to be skewed by age (presumably more pitchers would have been better).
The results of the above study are generally positive, but Jason Motte has yet to see his velocity return. There are a few different potential causes for Motte's drop. One variable is recovery time. Pitcher recovery time generally averages 17 months. Some of that time will be influenced by when the pitcher has the surgery, but Motte's recovery is still on the early side at just twelve months. Twelve months is a fairly arbitrary date, but there is some evidence to suggest that pitchers who began their minor league rehabilitation assignments within twelve months of surgery do not perform as well. Motte, with surgery at the beginning of May, falls barely within those parameters, and is still in the early stages of pitching compared to others recovering from the same procedure.
Motte is likely helped in his speedier than normal recovery by throwing few offspeed pitches. Pitchers are often limited in throwing sliders and curveballs when returning from Tommy John. Those pitches should not be a problem for Motte. He recently joked about his pitches.
"I still have got my pitch and a half," Motte joked. "I didn't reinvent myself. I'm not coming back with a 12-6 curveball."
In his last two full years of pitching, Motte has thrown just four sliders and zero curves according to Brooks Baseball. Motte's repertoire should not be limited out of the gate which should aid him in getting back to form.
Not every pitcher recovers from Tommy John surgery in the same way, and while the studies above are better at showing the broader results and implications from Tommy John surgery, very few pitchers can throw the ball as hard as Motte does. In looking over the list of players in the majors who have had Tommy John surgery from 2004-2010 and then cross-referencing that list with relievers from the same years who averaged more than 95 miles per hour within two years prior to the surgery we can find a few players similar to Motte velocity-wise.
The search yielded five players. Two pitchers, Tyler Yates and Ambiorix Burgos, never made it back to the majors, although it should be noted that they were not all that good to begin with. Three other players made the list.
Billy Wagner pitched well immediately, Frank Francisco took a bit longer to regain his form, and Gagne was never the same after his second Tommy John surgery. Neither of the players are a perfect match for Motte. Wagner was older, Gagne had previously had surgery and Francisco had only been in the league a year when he had surgery. Motte does not have many matches to begin with. As a converted catcher, he likely had considerably less stress on his arm coming up to the majors. Failing to reach 97 miles per hour at this stage of his recovery may be cause for concern, but given other, some quite likely, outcomes, throwing 95 miles per hour just one year following surgery is very encouraging.
Motte's effect on the Cardinals' season remains unknown, but for the second time in less than a week, the Cardinals are welcoming back a pitcher from a lengthy recovery following surgery. Motte's recovery is not as unlikely as Jaime Garcia's, but it is a tremendous recovery nonetheless. At one time, his goal was to lift his arm above his head. Now his goal is the scoreless outings like the one he provided last night. It is gratifying that Jason Motte was able to go through the former so we can now watch the latter.