Matt Moore faces Tommy John surgery in rare fate for Rays but increasing one in MLB

Matt Moore's elbow injury could sideline him for the entire 2014 season. (Orlin Wagner/AP) When Matt Moore exited Monday night's game against the Royals due to

Matt Moore's elbow injury could sideline him for the entire 2014 season. (Orlin Wagner/AP)

When Matt Moore exited Monday night's game against the Royals due to elbow soreness, it appeared that the Rays' lefty was bound for a stint on the disabled list. Since then, tests have revealed a tear in his ulnar collateral ligament, which means that he could be facing Tommy John surgery, which would knock him out until 2015. Such a loss would be a significant blow to the Rays, whose rotation isn't as deep as it once was, but it would mark the first time one of their major league pitchers underwent the surgery since 2009. It would also mark another Tommy John procedure in a season that's seen a staggering number of them already.

Moore underwent an MRI in Kansas City on Tuesday, but the results were inconclusive. A dye contrast MRI performed by Dr. James Andrews (the team's medical director as well as the sports world's most renowned orthopedic surgeon) on Wednesday revealed the tear. It's not believed to be a full thickness tear, leaving open the possibility of a non-surgical rehab for the 24-year-old southpaw, but without knowing how torn it is, all signs point toward surgery.

Though he missed five weeks due to elbow soreness last summer, Moore is coming off an otherwise strong season, with a 3.29 ERA (116 ERA+) and 8.6 strikeouts per nine in 150 1/3 innings. Of the six Tampa Bay starters who threw at least 100 innings, his strikeout rate was the highest, his ERA the second-lowest and his 2.6 Wins Above Replacement the third-highest. Even so, he battled command difficulties and a reduction in velocity last year; his walk rate ballooned to 4.5 per nine, while via BrooksBaseball.net, his average four-seam fastball speed fell to 93.3 mph, down from 94.9 in 2012, his first full major league season.

Moore's injury comes at a time when the Rays' rotation, once vaunted for its depth, has been thinned out considerably. Jeremy Hellickson underwent arthroscopic elbow surgery in early February and is likely sidelined until June, Alex Torres was traded to the Padres in January, and Alex Colome has been suspended for 50 games following a positive test for performance-enhancing drugs. The likely replacements for Moore in the current rotation  — which otherwise consists of David Price, Alex Cobb, Chris Archer and rookie Jake Odorizzi — are retread Erik Bedard and reliever Cesar Ramos, both lefties. The former, now 35 years old, spent last season with the Astros, where he threw 151 innings with a 4.59 ERA and 8.2 strikeouts per nine, offset by beefy home run and walk rates. The latter, who turns 30 on June 22, has just three starts in a six-year major league career; last year, he threw 67 1/3 innings out of Tampa Bay's bullpen with a 4.14 ERA and 7.1 strikeouts per nine. He has worked as a starter in the minors and was stretched out in that capacity this spring.

Additionally, top prospect Enny Romero, a 23-year-old lefty who threw 4 2/3 innings in his his major league debut last September 22, could figure into the team's plans by midsummer. He spent most of last season at Double-A Montgomery, where he posted a 2.76 ERA but walked 4.7 per nine in 140 1/3 innings. Baseball Prospectus recently ranked him 90th on their Top 101 Prospects list, with Jason Parks noting his mid-90s fastball and potential for a wipeout curveball but also "well below-average command" borne of an inconsistent delivery. With just four starts above Double-A, he'll have to tighten that up before the Rays throw him into the fire.

If Moore does undergo Tommy John surgery, he would be at least the 17th pitcher to do so in 2014, according to the data at BaseballHeatMaps.com. That list includes Kris Medlen, Jarrod Parker and Patrick Corbin, all of whom spent last season as frontline starters in the majors, as did Moore. The recent wave of TJs, which has also included top prospect Jameson Taillon, high-profile relievers such as Luke Hochevar, David Hernandez and Bobby Parnell, and second surgeries for Medlen, Parker, Brandon Beachy and Cory Luebke, has led to a whole lot of discussion about the procedure and whether baseball is experiencing some kind of epidemic as far as elbow problems go.

If one extrapolates this year's early-season data across the full calendar year, that would appear to be the case, but it's too early to tell. Aside from a spike in 2012, the number of major league players hasn't varied a whole lot across the past decade, though if present rates continue, 2014 could approach that high:

As Dr. Andrews himself pointed out via an interview on Sirius/XM's "Power Alley" with Mike Ferrin and Jim Duquette, the recent rise in such surgeries may have more to do with the legacy of overuse at the high school level via year-round competition than with sudden carelessness among major league teams. Young pitchers whose bodies are still developing are being pressured to light up radar guns (85 mph or above in high school is a risk) and to throw more breaking balls. Not only are their elbows simply not ready for that, but they're also not getting enough rest to recuperate from the impact of their work, which — particularly when it comes from playing in multiple leagues — is less likely to be coordinated in terms of minding innings and pitch count limits.

Beyond those factors, improved imaging technology has made it easier to diagnose UCL tears (not to mention other injuries), and the high success rate of TJ surgery has led pitchers to go under the knife soon after being diagnosed instead of spending a month or two attempting to rehabilitate the injury. According to a recent study by The American Journal for Sports Medicine involving 216 MLB pitchers who underwent the surgery from 1986 to 2012, 83 percent returned to the majors, and 97 percent at least pitched in the minors. Those rates are likely lowered by the long period covered, since the surgery — pioneered by the recently deceased Dr. Frank Jobe in 1974 — has been perfected by a newer wave of orthopedic surgeons including Andrews, Dr. Tim Kremcheck (the Reds' medical director) and Dr. Lewis Yocum (the Angels' medical director until his passing last year).

One thing that stands out given Andrews' relationship with the Rays — which goes back more than a decade — is how rarely their major leaguers have undergone the procedure. Via the aforementioned BaseballHeatMaps.com data, only one Rays major leaguer has received Tommy John surgery since the beginning of 2007: Jason Isringhausen in 2009. Even that should come with an asterisk, in that Isringhausen was 36 years old at the time and had endured at least six previous arm surgeries, including a 1998 TJ. The only other Rays major leaguer to undergo TJ since the start of 2004 was another reliever with a long injury history, Tyler Walker, in 2006. At that level and across that span, Tampa Bay's total is tied for the fewest among the 30 teams:

Team	MLB P TJ since 2004	Org TJ Since 2004
Angels	2	8
Brewers	2	10
Rays	2	11
Giants	3	6
Reds	3	16
Pirates	4	13
White Sox	4	7
Cubs	4	9
Rockies	4	11
Yankees	4	14
Twins	5	15
Orioles	6	16
Astros	6	8
Blue Jays	6	15
Padres	6	19
Mariners	7	11
Diamondbacks	7	15
Indians	7	17
Tigers	7	19
Nationals	7	14
Rangers	7	19
Red Sox	8	22
Marlins	8	15
Royals	9	15
Phillies	9	17
Dodgers	9	18
Mets	10	16
Cardinals	10	20
A's	11	20
Braves	12	20

It's probably noteworthy that Andrews' Rays, Yocum's Angels and Kremcheck's Reds are all among the least frequent recipients at the major league level. While those world-class doctors don't exclusively perform surgeries on the organizations with which they're affiliated, their teams may have a competitive advantage with regards to preventing such injuries. Of course, that could owe more than a little to the teams' front offices and scouting departments with regards to the pitchers they draft or otherwise acquire, since their tolerances for risk may vary.