For Sale

The future is uncertain for Chris Sale as he heads for Tommy John surgery, but the good thing for him is that he’s far from the first pitcher who’s needed the surgery.
Since Dr. Frank Jobe performed the first ulnar collateral reconstructive surgery on Tommy John in 1974, hundreds of major-league pitchers have had the same surgery, to varying degrees of success.
Jon Roegele, a writer for Fangraphs.com, is the curator of one of the most comprehensive lists of Tommy John surgeries among pitchers from high school through the majors. According to Rogele, 442 MLB pitchers have had Tommy John surgery over the past four decades.
There were 113 instances of the surgery for a pitcher over 30 years old, like Sale. In those cases, 86 times (76.1 percent) the pitcher returned to MLB action. The average recovery time (where accurate data are kept on surgery dates) before returning in those 113 surgeries was 17.8 months.
From that field of 113 surgeries, there were 10 examples of a pitcher making an All-Star team after his return. Among that same group, 48 had made All-Star appearances before having Tommy John surgery.
The Tommy John surgery has become so commonplace in baseball, it’s often thought of as a routine procedure. But it’s far from that, especially for veteran pitchers. The fact that just 10 pitchers returned to All-Star status after surgery could be a harbinger of bad news, but there are also several success stories Sale can follow.

• Tommy John himself was 31 at the time of surgery in 1974 and famously finished in the top five in the Cy Young voting in four of five seasons after he returned to the mound in 1976. John, who had a 19-month recovery period, played 13 more seasons after the surgery, posting a 3.66 ERA over 405 games and 382 starts.
• John Smoltz had the surgery at age 33 in 2000 and missed 14 months, but he pitched another nine seasons through age 42. Smoltz appeared out of the bullpen for the first three seasons after his surgery before re-entering the rotation at age 38 in 2005. From 2005 through 2007, he made no fewer than 32 starts, posting an average 3.22 ERA and earning two All-Star nods. He finished in the top 10 in Cy Young voting in 2006 and 2007.
• Tim Hudson, a perennial Cy Young candidate early in his career, had Tommy John surgery at age 32 in August 2008. He returned to the mound in September 2009, and during the 2010 season he earned an All-Star nod, posting a 2.83 ERA over 34 starts and 228 2/3 innings. Hudson pitched for five more seasons through his age-39 season, earning another All-Star bid in 2014, making 31 starts and posting a 3.57 ERA.
• Rich Hill had the surgery in 2011 in the midst of his first stint with the Red Sox. After a brief period of success when he returned to the mound in 2012, Hill struggled in 2013 and spent much of 2014 in the minors before pitching for an independent league team in 2015, when he was picked up again by the Red Sox and turned his career back around. Since 2015, Hill has posted a 2.91 ERA in 87 games, 86 starts.
• Another former Red Sox starter, John Lackey, had Tommy John at age 32 in November 2011 and returned in April 2013, a recovery time of 17 months. Lackey pitched at least 170 innings in each of his five seasons following surgery before retirement in 2017. In that stretch, he appeared in 153 games, 152 starts (averaging 30 per season) and posted a 3.57 ERA.
• Chris Carpenter, who won the NL Cy Young in 2005, had Tommy John surgery at age 32 in 2007 and returned after 12 months. In his first full year back in 2009, Carpenter finished second in Cy Young voting and had a league-leading 2.24 ERA, making 28 starts. He made 35 and 34 starts the next two seasons, averaging 236 innings and a 3.33 ERA at the ages of 35 and 36 before returning after the 2012 season at age 37.
On the flip side, some pitchers aren’t able to regain form following elbow surgery. Here are some of them:
• Scott Baker, a right-hander for the Twins, posted a 3.98 ERA over five seasons and 137 games, 134 starts, from 2007 to 2011 before needing surgery in 2012 at age 30. After 17 months, he returned to the majors but made only 30 more appearances, 13 starts, over the next three seasons with a 5.23 ERA before retiring.
• Joel Hanrahan appeared in just nine games out of the bullpen for the Red Sox in 2013 after his trade from Pittsburgh. Hanrahan landed on the disabled list in May 2013 with a flexor strain and subsequently had Tommy John surgery but never pitched another major-league game.
• Jason Isringhausen had three Tommy John surgeries, his second one coming in August 2008 at age 35. He returned surprisingly quickly to pitch in May 2009, just nine months later, only to land back on the injured list and needing the surgery again in June 2009. Upon returning in 2011, he did pitch 103 more relief appearances over the next two seasons before retiring in 2012.
• Similarly, Joe Nathan had two Tommy John surgeries after the age of 30. His first, in 2011 at the age of 35, kept him out 12 months, but he returned strong and made All-Star appearances in 2012 and 2013 with 67 and 66 games. But after a second surgery in 2015, he appeared in only a handful more games.
The road ahead for Sale is unpredictable at best. History shows that elite pitchers on Sale’s level — like Smoltz and Hudson, for example — have returned strong following elbow surgery after the age of 30, but there are risks aplenty, and durability and success after the fact are not guaranteed.

The Infamous Tommy John