MLB sees drop in Tommy John surgeries in 2016, but will it last?

Pitchers are still going under the knife for Tommy John surgery, but at a far lesser rate than the last two years. Is it merely a blip or a sign of something good?

A Cardinals team already beset by injuries got more bad news this week, as St. Louis learned that 24-year-old lefty Marco Gonzales will miss this season due to Tommy John surgery. His injury is the latest blow not only to the organization but also to a well-regarded prospect who has battled arm troubles over the past two years. But while it's cold comfort to the pitcher and his team, it's worth noting that this spring has seen a dip in the the numbing frequency with which pitchers have worn a path to the operating table for such surgeries. That said, it's too early to tell if this is just a temporary blip within what has been termed an epidemic.

A 2013 first-round pick out of Gonzaga University, Gonzales rode the express train to the majors, debuting on July 25, 2014. He pitched a total of 34 2/3 innings across five starts and five relief appearances spread over two stints with the big club, then made six postseason appearances in relief. His regular-season numbers (4.15 ERA, 4.75 FIP, 5.5 walks per nine, 8.0 strikeouts per nine) weren't remarkable due to control issues, but the Cardinals saw enough to include him on their postseason roster, and he wound up notching a pair of wins in the Division Series against the Dodgers. His stuff—particularly a circle changeup that grades out as a plus-plus pitch—continued to draw favorable reviews, with scouts and prospect hounds viewing him as a future third or fourth starter. He entered the 2015 season ranked 50th on Baseball America's Top 100 Prospects list, 52nd on that of Baseball Prospectus and 64th on that of ESPN. Along with Carlos Martinez and Michael Wacha, he was expected to be a key component of the team's staff at some point in the season.

Things didn't unfold that way, however. Optioned to Triple A Memphis to start the year, Gonzales scuffled and then battled shoulder woes that limited him to just 80 2/3 minor league innings with a 4.69 ERA; he was tattooed for a 5.45 mark in 69 1/3 innings in the hitter-friendly Pacific Coast League and served up 1.3 homers per nine. Recalled on Sept. 1 to make a start against the Nationals in place of Martinez, he didn't make it out of the third inning and was soon shut down for the season. His stock slipped enough that he cracked only the ESPN Top 100 Prospects list (at No. 74) this spring, though he was still considered one of the team's top 10 prospects by all of the major outlets. But shortly after being sent down to Memphis in late March, he told the team he was dealing with elbow pain, and after making the rounds with doctors, he and the team reached the conclusion that surgery was necessary, meaning that he likely won't pitch competitively until the middle of next season.

Beyond the losses of shortstops Jhonny Peralta and Ruben Tejada as well as backup catcher Brayan Peña, the Cardinals' pitching depth has taken considerable hits this spring. With Lance Lynn having undergone TJ surgery last November, the team entered the year with a rotation of Adam Wainwright, Martinez, Wacha, Jaime Garcia and free-agent signing Mike Leake—a group with plenty of upside but no pitcher who threw 200 innings in 2015. With top prospect Alex Reyes beginning the year serving a 50-game suspension due to a positive test for marijuana, Gonzales, Tyler Lyons and Tim Cooney were expected to be the top reinforcements. Lyons made the team as a reliever, but Cooney battled shoulder troubles in March, making Gonzales' loss that much more critical.

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It may be of no consolation to Gonzales, but this spring has been freer of headline-grabbing news with regards to Tommy John surgeries, and it’s not just because no Yu Darvish-caliber pitcher has hit operating table thus far. As with on-field performances, it’s too early to draw conclusions given the small sample sizes, but the trend is worth a look. Via the Tommy John Surgery database at Baseball Heat Maps—which has logged just shy of 1,200 professional surgeries dating back to that of Tommy John himself in 1974—so far this year, just five major league pitchers have undergone (or are scheduled to undergo) ulnar collateral ligament reconstruction: the Marlins' Carter Capps, the Braves' Andrew McKirahan, the Rockies' Jairo Diaz, the Athletics' Felix Doubront and the Royals' Tim Collins. Since Gonzales wasn't on the major league roster when he was discovered to need the surgery, he doesn't count in that context, but including him and other minor leaguers such as Yankees prospect Nick Rumbelow (whose need for the surgery was reported earlier this week), the tally so far is 13 pitchers.

Through April 15 of last year (I'm using that date because the database uses it for Gonzales, Collins and Rumbelow), 10 major leaguer pitchers and 29 professional pitchers in all had the surgery; note that I'm excluding from that count any pitcher whose surgery is dated on Jan. 1 of that year, as that's the shorthand for a minor leaguer with an unknown surgical date within that calendar year, and I'm also excluding position players. With that in mind, let's put this year’s numbers in context:

	mlb 4/15	all 4/15	mlb year	all year
2016	5	13
2015	10	29	25	104
2014	11	28	30	106
2013	5	11	19	78
2012	8	20	35	91
2011	2	8	15	64
2010	4	16	13	65
2009	2	7	18	63
2009–13 avg.	4.2	12.4	20.0	72.2
2014–15 avg.	10.5	28.5	27.5	105.0

The past two years have been boom times for orthopedic surgeons performing Tommy John, and the early season has served as something of a bellwether, with a 150% increase in the number of major league pitchers undergoing surgery by this point relative to the previous five years, and a 38% increase in the final-year totals; for all professional pitchers, the increases were 130% and 45%. It's worth noting that all of these counts are unofficial; that minor league data is harder to come by than major league data given how some teams tend to be more guarded with such information; and that the increased level of scrutiny created by the 2012 spike may mean that we're simply getting more accurate reporting than before. Some of those date-unknown surgeries are probably missing from the early-season counts.

Still, the fact that this year’s early-season numbers are closer to the 2009–13 levels than to the past two years does offer a glimmer of hope that we’ll see a corresponding drop in the year-end numbers. But as with any early-season trend, it's hazardous to draw firm conclusions from small sample sizes. What’s more, it’s far too early to suggest that these numbers are down because teams are suddenly managing pitchers’ elbows better than before thanks to pitch counts, innings limits and medical advances, or that the American Sports Medicine Institute’s 2014 position paper has led to better practices in amateur ball—where year-round play and haphazard monitoring of workloads and mechanics have fueled the epidemic—which in turn have suddenly brought a healthier wave of pitchers into the professional ranks. It will take years to know whether that effort has had an impact.

More likely, like all of those players currently carrying batting averages above .400, we’re seeing a patch of good luck with Tommy John surgery that might escape notice if it weren’t at the start of the season. At most, we can dream it holds up.