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Article: It's Official: Sano to have Tommy John Surgery


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Even if the surgery had been in November, this is more unfortunate for Miguel Sano in 2014, but of limited importance to the Twins in 2014. However, it could turn out to be good news for both Sano and the Twins in 2015.

 

You'd think it would go without saying, but some comments seem annoyed that he did not have surgery earlier. Surgery is painful and all surgeries have risks of being effective or worse, even if done by the best surgeon, and recovery is lonely and a lot less fun than playing a game like baseball. There is also continued doubt about whether you will lose your fitness or technique. His schedule makes complete sense - he should, as he is doing, take a few weeks to relax and see his family, because once he has the surgery, he is going to commence a well-established, but arduous path of recovery. All of us need to wish him well as he goes through this process. Second-guessing the timing doesn't help anyone and is also based only on the weak circumstantial evidence of "they seem to have been wrong before; therefore, I think they were wrong this time, also."

 

However, even if the timing was wrong, it is of little impact on the Twins. If Sano had had surgery in November, as some comments suggest, AND, if he had recovered sufficiently to play for the Twins after 8-10 months AND play well, his impact on the Twins in 2014 would have been small. Last year, Trevor Plouffe was a 1.9 WAR (BRef). Miguel Cabrera, in his rookie year (which could be one of the best comps for Miguel Sano), was less than a 1.0 WAR (BRef). At best, if he had surgery, Sano would have played half a season. Even if - in that half-year - he produced better than Cabrera did in his rookie season and Plouffe has a bad year (my guess is that Plouffe has an OK year this year), the difference between them would have been small, so the impact of Sano on the team in 2014 would have been small. Frankly, the best chance for Sano to meaningfully impact the Twins in 2014 would have been for rest and recovery to have succeeded, so that he could play the full year.

 

Now, he is going to spend a year getting in shape. He's going to work on strengthening exercises that he may not have been able to do this past year, out of worry that they would have hurt him. He's also going to feel like he has something to prove, likely even more than he does regularly. When he comes to 2015 spring training, he'll likely have a chip on his shoulder that meets Gardy's newly stated preference for players with attitude. Unless there is a setback in his surgery or recovery, he will make it clear that he belongs in the majors in 2015.

 

There is precedent. In 1994, Chipper Jones was about to start his rookie year as the Braves' third baseman when he tore up his knee. He missed the whole year, but came back the next year and was a major contributor to the Braves' winning the World Series. For a non-pitcher, a knee is worse than an elbow. Although it is tough to predict a World Series for a team that doesn't have a pitching staff equivalent to Maddux, Glavine, Smoltz, etc., it seems realistic that Sano could have an impact on the 2015 Twins equivalent to the impact Chipper Jones had on the 1995 Braves.

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The more I thought about this the past couple days, the more my anger over it subsided. If Sano was opposed to it in November and Dr. Andrews recommended rest, there was no way they were doing the surgery. I still don't know why there was no MRI last year in New Britain since it was reportedly bothering him then too.

 

I think Sano has way too much pride to let this set him back, assuming all goes well with the surgery and he doesn't try to rush back. Given the timing, he won't be under any pressure to rush back to playing the field this year. And as many other's have commented, we'll be heading into 2015 with Buxton and Sano ready to go (hopefully).

 

Even though I still think this could have been avoided (by doing the surgery in August or September) Sano and his doctor decided to try rest first. It will probably end up costing Sano a half year to a full year in service time, but it was his call.

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What is the moral stand on surgery for ball players? In all other matters employees do what their employers tell them to do but not for surgery. To me that is appropriate but how about simply "resting" or not? I would think that should be a compromise between the ballclub and the players. But perhaps surgery should be also. Opinions on this one please.

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Guest USAFChief
What is the moral stand on surgery for ball players? In all other matters employees do what their employers tell them to do but not for surgery. To me that is appropriate but how about simply "resting" or not? I would think that should be a compromise between the ballclub and the players. But perhaps surgery should be also. Opinions on this one please.

I guess my opinion is that medical matters are between me and my doctor.

 

If my performance at work is affected by my refusal to get needed medical treatment, I think that's fair game for my employer. But I don't think they have any right to mandate anything medical.

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I don't think any coach or manager could "mandate" that an athlete has surgery, but they can certainly not play them if the athlete doesn't return to pre-injury performance with rest and rehab. [iMO] The Twins have a solid medical staff, and they already gave the non-operative a try for quite some time.. no dice.

 

The other big piece of the pie though is the athlete's motivation to get back in the game. If their sport is not only the bread n butter (or chicken and rice ;) ) of life but also the source of their income… they're probably eager to listen to the expert's recommendation (and hopefully get two). They want to move forward to hopefully get through rehab as good as or better than before.

 

As a competitive athlete who's been under the knife a few/five times, there is a lot of psychology wrapped up in navigating injuries. To take no action, wait it out, and hope for the best "in due time" is a pretty helpless feeling, and rest and daily PT can definitely feel like no action when yore not seeing commensurate improvement. Flipping into my clinical mindset... I don't think an athlete should just jump on the table and wait for the propofol at the first sign of an injury. In general though, I don't think the coaching staff has to bargain much - in my experience the athlete is usually the one who wants to cut first.

 

(God bless and my apologies to anyone I ran across during my rehab and pre-op days.

:angry: )

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My experience with this has been that most commonly there is an open discussion between the surgeon(s), player, agent and the team. Every situation is a little bit different in terms of the quality of player, significance of injury, contract status, time of year, previous injuries or surgery, prior treatment, goals of the player (both short and long term), goals of the team (same), age of the player, and probably a half dozen other things I haven't listed. Often times in cases of a premier player, they will see multiple surgeons who will frequently communicate with each other. Ultimately, the responsibility of the surgeon is to serve the best interests of the player, but there is frequently input from the team as to their preference in treatment. In the majority of cases all parties are able to come to an understanding regarding the best way to proceed. At the end of the day, it is the player's decision.

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My experience with this has been that most commonly there is an open discussion between the surgeon(s), player, agent and the team. Every situation is a little bit different in terms of the quality of player, significance of injury, contract status, time of year, previous injuries or surgery, prior treatment, goals of the player (both short and long term), goals of the team (same), age of the player, and probably a half dozen other things I haven't listed. Often times in cases of a premier player, they will see multiple surgeons who will frequently communicate with each other. Ultimately, the responsibility of the surgeon is to serve the best interests of the player, but there is frequently input from the team as to their preference in treatment. In the majority of cases all parties are able to come to an understanding regarding the best way to proceed. At the end of the day, it is the player's decision.

 

Thanks again for your expertise and insight into this.

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Question: How common is it for partial tears to heal? I'm not aware of a case. Anybody?

 

Albert Pujols has had a partial tear in his elbow since 2003. He has had bone spurs removed and nerve transposition in his elbow but not TJ surgery.

 

I stumbled across this from MLBTradeRumors this morning. In a post concerning Ervin Santana's issues regarding his representation and some concerns among teams regarding his health, there was the following paragraph:

Santana, however, pitched through a UCL injury for years without requiring Tommy John surgery, and this past October, esteemed surgeon doctor James Andrews stated,
"[santana] doesn’t need any further treatment for his right elbow partial UCL tear, as on (the) MRI today it appears that it has completely healed."
(As reported
.) That, of course, doesn't mean that every team doctor will agree with the assessment, but Andrews' opinion would be considered among the most highly regarded in the industry.

 

If a pitcher who throws as many sliders as Santana does has been able to play through a UCL partial tear without TJ surgery, it wouldn't seem unreasonable for Sano to try to do so, as well.

 

I wasn't aware that Santana had this in his medical history. Maybe I knew at one time, but since he never had surgery, I just never gave it any additional thought. Along those lines, I suspect that one reason we have trouble coming up with examples of where "rest and rehab" have worked is that those cases don't get the attention that TJ surgeries do.

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