Usually, the end of a season like this one – promising but sabotaged to the core by an outrageous abundance of injuries – brings sweet relief. The offseason, theoretically, provides an opportunity for banged-up players to get right and return in the spring at 100% physically.
In the cases of many Twins, it's difficult to envision things going so smoothly.
Here's a look at seven players – all varying levels of vital to the 2023 outlook – who will have their unusual injury concerns and uncertainties ripple forward into next year.
Tyler Mahle, SP
No one could seem to figure out what was wrong with Mahle's shoulder this year. Not the Reds, not the Twins, not the pitcher himself ... certainly not any outside observer. His issue was described in different ways at different points – strain, soreness, fatigue, inflammation – but throughout out it all, repeated exams showed no structural damage.
So, we don't know what's going on. What we do know is that Mahle's final two attempts to pitch this season saw him induce three swinging strikes on 74 pitches while flashing significantly reduced velocity, getting removed after two innings in each.
Now he's got an offseason to rest up and get right. But, what does "getting right" mean when no one could pinpoint what was wrong to begin with?
This is one scenario where I feel like the Twins front office and medical staff are getting a bit of an unfair shake. They gambled on Mahle because his scans were clean and he was pitching well at the time. He kept pitching well for a bit. Then the shoulder troubles resurfaced, yet the scans remained clean.
Pointing fingers at team doctors is easy but misguided. It's not like they aren't consulting outside specialists at the top of their field. The reality is that for all of our advances, sports medicine remains an inexact and often mysterious science. Mahle is a good example. He's hardly the only one.
Byron Buxton, CF
I'm not going to act like this is anything new. Buxton, obviously, has to be viewed as an availability question mark heading into every season. But at least last year he didn't carry any blatant health burdens directly into the offseason.
In 2021, Buxton played through the end of the schedule and flat-out mashed down the stretch, posting a 1.001 OPS with nine homers after September 1st. His broken hand had healed, and he was seemingly past the hip strain that earlier cost him six weeks. This year, that same hip forced him back to the injured list. That's in addition to a persistent right knee tendinitis, with both trending toward the dreaded "chronic" category of classification.
These dark clouds will hover over Buxton, recipient of a new $100 million contract, for the foreseeable future. Outside of an ostensibly minor procedure conducted last week to clean up scar tissue and frayed ligaments in his knee, there's nothing but hope to guide us toward a significantly better outcome for Buxton next year.
"What ends up typically happening is the scar tissue and otherwise creates more of that inflammation when you pound on it. So, now let's clear out some of that and hopefully that'll alleviate some of that stress going forward," said chief baseball officer Derek Falvey.
Alex Kirilloff, OF/1B
Perhaps the most perplexing and inscrutable health situation among many faced by the Twins franchise.
In August of 2021, Kirilloff underwent season-ending surgery to address a torn wrist ligament, with the hope that creating more spacing would alleviate the pain experienced while engaging his elite swing.
It didn't work. Or at least not for long. Kiriloff battled more pain in spring training and the early season, took a short break, went to Triple-A, dominated for a month, returned to the majors, and then it all came roaring back. The pain, the warped swing mechanics, the endless ground balls. Cortisone injections offered only brief respite from his performance-draining affliction.
Thus, Kirilloff and the Twins turned to a last-ditch option: a more invasive surgery that involves "breaking the ulna and shortening it before the insertion of a metal plate and screws," another effort to create space in his wrist.
"I really hope it doesn’t get to that," the 24-year-old had lamented earlier in the season.
While relatively common for the general population, this procedure is rare for professional athletes and there aren't many past examples to reference.
In a recent update to the media, Falvey mentioned that Kirilloff "hasn't ramped up his hitting progression yet," adding that there have been no setbacks or delays but "we just don't want him to hit yet." Kirilloff had undergone the surgery six weeks prior, for whatever that's worth.
I want so badly to feel optimistic about Kirilloff because his talent level and upside can be game-changing for this franchise – if only he could tap them for a prolonged period on the field. But it's getting really difficult to find that optimism, and his wayward status creates all sorts of planning headaches for the front office.
Royce Lewis, SS
Speaking of planning headaches, we have the shortstop position. Lewis showed the makings of a long-term fixture during his brief audition this year, but unfortunately that concluded in late May when he re-tore the very same knee ligament he'd just spent a year rehabbing from reconstructive surgery.
In somewhat positive news, he only partially tore the ACL this time, and surgeons put a novel twist on his second knee operation; mentions of a "brace" being involved in this variation led Lucas Seehafer to conclude they employed a technique called lateral tenodesis.
While promising in its potential to prevent another injury, Lucas framed this technique as somewhat experimental, adding that "the long-term outcomes for this procedure in the athletic population, and specifically the MLB population, [are] unknown."
Even if he's able to come back with a structurally sound, twice-repaired knee ligament, it remains to be seen whether Lewis will be able to maintain the full speed, quickness, and lateral agility that were on display even after his first surgery.
Like Kirilloff, Lewis brings much to the table as a building block for this franchise, which makes his uncertainty all the more unfortunate, surfarcing some difficult short-term decisions for the front office with regards to the future at shortstop.
Chris Paddack, SP
The Twins knew they were taking on risk when they acquired Paddack as the centerpiece of the Taylor Rogers trade, but even in that context, they've pretty much stumbled into a worst-case scenario. Paddack made it through five starts before the partial tear in his UCL, already once repaired via Tommy John surgery, gave way and necessitated to a second TJ procedure.
The history of pitchers who have undergone this ligament replacement surgery twice is not the most encouraging. Mike Clevinger, one of the most accomplished pitchers to undergo a Tommy John revision surgery (in November 2020), returned to action this year and while he's managed to throw more than 100 innings, Clevinger is nowhere near his pre-surgery form. There are complicated realities at play with getting this repair a second time that have diminished the rate of success.
"On average, the typical TJ revision isn’t as successful as the typical primary TJ,” said Dr. Andrew Cosgarea, an orthopedic surgeon and professor, in a story for the San Diego Union-Tribune. "The first time you drill a hole in the bone it is fresh and clean, but if it happens again you already have a hole there and that hole is filled with scar tissue. … Scar tissue isn’t as healthy as original tissue. It doesn’t have the same blood supply; (it is) not as durable.”
Paddack has already acknowledged that he's realistically targeting an August return next year, setting expectations for a 14-month recovery time and reducing the likelihood he'll be able to make a significant impact in 2023. We probably should collectively drop the notion of Paddack pitching in the Twins rotation again before his team control expires after 2024.
Kenta Maeda, SP
Relatively speaking, Maeda's outlook is less complicated than Paddack's since he's coming off his first Tommy John surgery. However, the veteran righty still hasn't taken the mound 13 months after his own procedure "with a twist" – an internal brace designed to shorten the recovery timetable from the typical 12-16 months down to 9-12.
Alas, he'll be nearly 18 months removed by the time he hits the mound again next spring in Ft. Myers. That Maeda didn't make it back this year isn't a big deal – the timing of his surgery late last year was always going to make it tough, and the Twins being out of contention in September rendered it a moot point. The bigger concern here is that he'll be a 35-year-old coming back from significant elbow surgery and a very long layoff, with 173 total innings pitched over the past three seasons.
It's hard to foresee him successfully taking on a full starter's workload in his final year under contract, so I'll be curious to see how he fits into the 2022 plan.
Josh Winder, SP
Winder was limited to 72 innings last year, and will finish near the same total this year, because of recurring "shoulder impingement" issues that he and the club appear unable to fully diagnose or solve.
“He’s felt good for periods of time. He’s thrown the ball well for periods of time. There’s no singular reason why we’re looking at this and thinking, ‘Well, this is why this is happening,’ to be honest,” manager Rocco Baldelli said in late July, shortly after Winder had been placed on IL for a second time with what was by then being termed impingement syndrome. “It’s just soreness that keeps creeping back in there.”
Winder wouldn't make it back to the big-league mound for another seven weeks after that, and while he was able to return for four starts in September, he wasn't very effective, posting a 5.59 ERA in 19 ⅓ innings.
Much like with Mahle, it's difficult to feel confident in an injury clearing up when nobody can get to the bottom of it. Winder, for his part, has suggested he "might just be at a predisposition for this type of injury." Which makes him pretty challenging to plan around, and that's a big hit because he showed the makings of a signature product of this front office's pitching pipeline.
The Twins liked him so much they went out of their way to keep him on the Opening Day pitching staff this year. They were envisioning him as an integral part of their rotation mix this year. I don't see how they can keep doing so going forward.
An Uncertain Future
In the recent media scrum where he updated a litany of injury situations, Falvey remarked on the avalanche of IL stints that buried the team this year, reasoning that – to some extent – you're at the mercy of fate. Like all things in baseball, injuries ebb and flow.
"I'm hopeful, for a lot of reasons that this is our spike-up year and that there's some regression built in going forward," Falvey said. A reasonable mindset, from a basic analytical standpoint.
And yet, as these seven examples show, many of the dismal developments in the spike-up year that was 2022 could prove thorny going forward.