A Second Tommy John Surgery for Shohei Ohtani May Present Greater Challenges, Though Not Guaranteed

Should Shohei Ohtani undergo a second Tommy John surgery, the road to recovery could be more arduous than his first experience, although this is not certain.

Chicago Cubs pitcher Jameson Taillon offers personal insight, stating that his first Tommy John rehab was extremely challenging, and he never quite felt completely healed. However, he found that his second surgery was akin to getting a “new arm.”

Ohtani, a player of unparalleled versatility, damaged the ulnar collateral ligament in his right elbow during a match against the Cincinnati Reds on August 26. While he continues to serve as a designated hitter, he has been sidelined from pitching for the remainder of the year as he contemplates his medical alternatives.

Ohtani underwent his first Tommy John surgery on October 1, 2018, executed by Los Angeles Dodgers’ chief team physician Neal ElAttrache. He made his comeback to the Los Angeles Angels initially as a batter on May 7, 2019, and resumed pitching duties on July 26, 2020, in a season delayed by the global pandemic. His initial return to the mound was less than stellar; he managed only five outs on August 2 before exiting the game due to a forearm strain, sidelining him from pitching until 2021.

Since his return, Ohtani has amassed an impressive record of 34 wins and 16 losses in 74 starts, with a 2.84 ERA. Alongside his batting statistics over the past three seasons—a .278 average, 124 home runs, 290 RBIs, and 56 stolen bases—speculations were rife that Ohtani could secure a record-breaking contract exceeding $500 million as a free agent this offseason.

Should Ohtani decide to undergo the surgery, his earliest possible return to pitching would be in 2025. Typical recovery times for pitchers vary from 12 to 18 months, although some position players have returned more rapidly. For instance, Philadelphia’s Bryce Harper returned to his designated hitter role in May, a mere 160 days post-surgery.

In the medical realm, the ulnar collateral ligament connects the humerus and ulna bones at the elbow. Surgeons typically replace the torn ligament with an almaris longus tendon from the forearm. If that is not feasible, the gracilus tendon from the knee is the alternative.

Second surgeries often present complications, including elongated recovery periods due to factors like scar tissue and bone spurs. Dr. David Altchek, New York Mets’ medical director, noted that pitchers could generally resume throwing by week 17 after their first surgery. However, following a second surgery, this could be delayed to week 21 or even 41.

Dr. Altchek, a veteran of 1,800 Tommy John surgeries, also cited an increased re-tear rate and suggested that training methods involving weighted balls could exacerbate the issue.

Angels’ General Manager Perry Minasian has yet to disclose the full details of Ohtani’s ligament tear, stating that consultations with medical professionals are ongoing. Dr. Matthew Best, an orthopedic surgeon and director of research at Johns Hopkins’ Sports Medicine Division, emphasized the need for more information to ascertain the suitable recovery process or the necessity of another surgery.

Baseball analyst Jon Roegele has documented 2,345 Tommy John surgeries since its inception in 1974, and notes that 148 players have had the surgery twice. Yankees’ chief team physician Christopher S. Ahmad of Columbia University remarked that although second surgeries present difficulties related to scar tissue and altered anatomy, success rates have been improving, now ranging between 60% and 70%.

Prominent among the successful comebacks from a second Tommy John surgery are Nathan Eovaldi and Jameson Taillon, while Hyun Jin Ryu returned last month, Walker Buehler is approaching a return, and Jacob deGrom underwent his second surgery in June.

Dr. Altchek concludes that the healing environment post-second surgery is less than optimal, given that the area has already been subject to surgical interventions.

Contributions to this report were made by freelance writer John Perrotto.

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