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Heezy1323 last won the day on April 1 2020

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  1. I propose a thought exercise. I believe most would agree (regardless of position on robo umps) that calling balls and strikes in a game of 10-year-olds is easier than at the MLB level. What is the reason, exactly? Presumably, it is because the pitches are coming in much more slowly, and are breaking a much smaller distance. For the sake of argument, let's take this to an extreme. Let's pretend that the ability of pitchers to continue to improve their velocity knows no limit. Let's pretend that, say, 20 years from now it is routine to have pitchers throwing 110-115mph. Perhaps with even more break. What is the upper limit of human ability to make ball/strike calls with reasonable accuracy? Clearly if a baseball is coming in at 200mph, and breaking 30" or something, a human brain has no shot at telling if the ball goes through a defined box- particularly on borderline pitches. And logically, there is also a gradient along the way, such that with increasing velocity and break, the ability of even the best umpires to delineate balls from strikes goes down. Where, precisely, is the threshold at which this becomes 'unacceptable'? We already use computers in thousands of scenarios every day where the ability of the human senses is unable to reasonably discern one situation from another. I view this as no different. I don't believe it's because the umpires are necessarily 'bad' at their job. I just don't think it's reasonable to expect even those most skilled to be able to do this correctly 100% of the time. We've all seen games, series or even careers turn on ball/strike calls that were bad. We either have, or soon will have, the ability to be better. It's time. I can't imagine a scenario where a human is calling balls and strikes even 10 years from now. Merry Christmas TD. All the best to each of you.
  2. Agreed on the good ice/bad ice analogy. Not sure I follow the second paragraph. The purpose of the internal brace is to avoid stretching of the graft (by resisting tension/reducing stress) during it's initial period of relative weakness after implantation, and perhaps some degree of protection of the graft going forward by acting as a sort of 'rebar.' This allows the graft to heal in at a more desirable (i.e. tighter) tension, rather than becoming loosened, as it might without the internal brace in place.
  3. Ok- I'll give it a shot. Hopefully there's something valuable I can share. I did not see the STrib article (my bad, would've liked to read it), but I have been aware of the internal brace concept being utilized with UCL reconstructions for a short time. Feel free to review my prior blog post about UCL injuries. Nomenclature is important here. Recall that UCL repair means that the athlete's own ulnar collateral ligament (UCL) is repaired back to bone. This repair is often protected with an especially strong suture called an 'internal brace'. The internal brace has been around for a number of years. It has been (and is currently) used in a number of other places in the body to protect various ligament or tendon repairs. It began (if I recall correctly) being used to help protect the repair of ligaments at the outside part of the ankle when patients required surgery for chronic ankle instability. With it's success there, it has gradually been expanded to other parts of the body. By way of example, I have used it in basically every one of my ACL reconstructions for the past 2.5 years to protect the healing graft during recovery (somewhere around 150 ACL's). I have also used it to help protect PCL, MCL, patellar tendon and posterolateral corner surgeries in the knee, among others. When the UCL is repaired, the idea is that the tissue of the UCL is healthy/strong enough that it can successfully withstand the forces of pitching once it has become firmly healed back to the bone. The injury in these cases is to the area where the ligament meets the bone, not within the ligament itself. The purpose of the internal brace in this case is to 'protect' the repair. Specifically, when a patient moves the elbow after surgery (even if they aren't doing something demanding such as throwing), there is microscopic movement at the interface between the healing ligament and the bone. In theory, if there is excessive stress at this junction, the healing will be less robust and therefore the ligament less able to withstand substantial forces of throwing later on in the rehab process. By using an internal brace, the idea (as I understand it), is that the relatively small forces of day to day movements of the elbow are now shared between the healing ligament and the internal brace suture. Therefore, this stress is less likely to cause a negative effect on the healing progress of the ligament back to the bone. Hopefully (the idea goes) this results in more strong and robust amount of healing of the ligament when compared to a repair done without an internal brace. (Feel free to review my previous blog post about UCL repair vs. reconstruction here.) That leads us to this particular case with Kenta of a UCL reconstruction performed with an internal brace. This is similar, but not identical to the situation discussed above. Recall that the term 'reconstruction' is used when tissue (almost always a TENDON) from somewhere else (either the patient themselves or in some cases a donor/cadaver) is used to make a NEW ligament. There are numerous reasons why this option might be chosen rather than a repair, but most commonly it is because there is an accumulation of damage to the native ligament that makes it unlikely to be strong enough itself to stand up to the necessary stresses once healed. Indeed, most UCL repairs are performed on young athletes who don't have the same cumulative amount of damage as MLB pitchers. As a result of this, there is an additional variable in these cases of reconstruction. Namely, in addition to successful healing, the TENDON also requires time to 'turn into' a LIGAMENT. This is primarily why the recovery from UCL repair surgery is typically so much shorter than UCL reconstruction --> in a UCL repair the ligament is already a ligament. So it doesn't require time to undergo this transition from tendon tissue to ligament tissue (called ligamentization). (I know this is getting tedious- and I apologize. Hang with me here...) So the use of the internal brace with UCL reconstruction has a slightly different goal than with primary repair (again, as I understand it). Obviously, when you use a tendon to replace a ligament, you have to remove that tendon from the body completely for a short time in order to reimplant it. As a result, the tendon is completely removed from its normal blood supply. Once implanted, the body has to reestablish blood supply to this tendon in its new location in order to keep it alive. This takes some time to accomplish. There have been animal studies done that have shown that the strength of the newly implanted tendon in situations such as this actually goes down for the first few weeks after surgery, then starts to increase again. As a result, there is a period of time after surgery when this graft is vulnerable to 'stretching out' which could compromise the ultimate strength of the graft. The internal brace seeks to avoid this problem by protecting or 'bracing' the graft during this period of time so that it doesn't stretch out and is able to heal in more strongly and at the appropriate tension. How much difference in 'looseness' (what we would call laxity) is too much? Well, during my fellowship with Dr. Andrews we did a study that showed that when placed under stress, the injured elbow opened up on average only 0.3mm (that's a third of a millimeter!) more than their opposite, uninjured elbow. So it appears that it doesn't take much difference in laxity to cause a problem in a thrower's elbow. There is a mountain of data supporting the use of an internal brace with UCL repair. There is very little data available that I am able to find regarding the use of an internal brace with UCL reconstruction. I found one biomechanical paper that showed that the use of an internal brace with UCL reconstruction allowed the biomechanics of the elbow to more closely replicate a normal elbow than when UCL reconstruction was done without internal brace (this was a cadaver study). I was not able to find any clinical data reporting on the success rate of UCL reconstructions done with internal brace compared to those done without. My guess is that this data is coming, just not published yet. Logically, it makes a lot of sense to me that the use of an internal brace in conjunction with a UCL reconstruction would improve the success rate, but medicine doesn't always follow logic. I'll be interested to see the results in the future. Also, I don't know exactly which reconstruction technique Dr. Meister uses, which could potentially have some influence on results as well. One reservation I have about the idea that this internal brace shortens the return to play timeline is that despite the fact that this internal brace likely results in a 'tighter' ligament once healing is complete, the internal brace probably does not do anything to speed up the transition of the tendon tissue into ligament tissue that occurs over time. Perhaps we can be a bit more aggressive with the rehab when an internal brace is present, without as much concern for the new ligament 'stretching out'. But ultimately, the new ligament has to be (very) strong in order to withstand the extreme forces of pitching, especially at the MLB level. Time will tell if this new modification to UCL reconstruction technique will allow for a quicker return to play. I hope it does- 18 months is a darn long time. If you've managed to read this far- thank you. This is pretty dense stuff (sorry...)
  4. This is another HUGE variable in evaluation of these patients. The appearance of the UCL on MRI is often not particularly helpful. Let's go through the scenarios: 1) The UCL looks completely normal (rare at the MLB level): rest and rehab, perhaps a PRP injection 2) The UCL is completely torn, obvious to everyone that the athlete needs surgery (maybe 20% of the time): proceed with surgery in most cases, though on occasion PRP or other means of treatment can be tried. 3) The UCL is somewhere in between. Small to moderate damage, but nothing terrible (this is the case the majority of the time): A huge range of possibilities. Some pitchers can throw for years on a partially torn ligament. Others can have an MRI that looks essentially normal and can't throw without pain despite extensive non-surgery treatments. This is what makes these decisions REALLY hard in a lot of cases. The exact same MRI findings can indicate opposite things in two different patients. Trying to figure out which patients will be successful with non-surgical treatment is tough. And remember, the return to play rate after TJ surgery is quite good (somewhere around 90%), but that still means 1 in 10 will not get back. This is why, in many cases, the athlete has to 'prove' they aren't going to be successful without surgery by trying the rest and rehab route initially before proceeding with surgery. Sometimes the calendar, an athlete's contract status or year in school, or other factors will push us to surgery faster.
  5. This is mostly, but not completely accurate. Hill had a UCL repair in the sense that he did not have a new graft put in place, but simply had a direct repair of his existing ligament tissue. However, he had previously undergone UCL reconstruction in the early 2010s and as such had a repair of a previously reconstructed UCL, which is really a distinct situation from the vast majority of these operations in which the athlete's native ligament is reattached to the bone. Agree with Lucas that we will probably see more of these 'primary repair' operations going forward. Hopefully they will be able to reduce the time needed for recovery for a subset of UCL-injured players.
  6. Agree with Nine of twelve, this pitch looks to have hit him just at or above the wrist, almost certainly on the ulnar side. At the level of the wrist, the ulna is the smaller bone on the small finger side of the forearm. It's obviously hard to say exactly where this pitch hit him- whether it is a fracture of the ulna right at the wrist and into the wrist joint (what we would call intra-articular) or more on the shaft of the ulna (away from the joint a bit, within the bone itself or extra-articular). Neither is ideal, obviously, but you would prefer that the fracture be away from the joint so that there is less risk of damage to the cartilage of the wrist joint. Cartilage has less blood supply and therefore less healing potential when compared to bone. We do occasionally hear about injuries to part of the wrist cartilage in baseball players. This is called the Triangular Fibro-Cartilage Complex (TFCC for short). I believe Carl Crawford and Matt Holliday had this issue some years ago. I am hopeful this is a fracture above the wrist joint, and involves only the bone of the ulna. This would typically be fixed with a plate and several screws to hold the bone in the appropriate position while the body heals the fracture. Healing of these type of fractures often takes around 6-8 weeks. On occasion, ulna fractures can have trouble healing and may heal slowly, or in rare cases not heal at all. In those cases, sometimes additional surgery or other treatments may be needed to get the bone to heal. There are also tendons that glide close to the ulna in this area, and the sheath they glide in could potentially be damaged as well in this case. This can occasionally cause issues for baseball players as well (i.e. Mark Tiexeira). Overall, definitely a bummer for Rooker, who was having a nice start to his career. Without knowing details, it's difficult to comment on the time frame for recovery or the likelihood of this affecting him in the future. Let's hope it's a straightforward fracture and surgery goes smoothly. I know the Twins have an excellent group of physicians to take great care of him. Let me know if folks have questions or would like me to clarify anything. GO TWINS!!!
  7. "Of course there are undoubtably additional factors that put pitchers at risk for arm injuries. Twins Daily’s very own medical expert, Lucas Seehafer, did a great job of illustrating the roll proper mechanics can play in pitcher injury prevention and the increase of specialization at a young age has also been cited as a potential cause of injury. College and minor league pitchers have a much higher rate of Tommy John surgery than their MLB counterparts, which fits our narrative as they’re likely to be throwing a higher mix of fastballs and have less developed mechanics." As a clarification of perspective, there are a greater number of TJ surgeries performed on college and minor league players when compared to MLB; however, there are MANY more players at the college and minor league level than MLB. As such the raw number is higher in college and MiLB, but the rate is much higher in MLB. There is definitely information to take away from this fact (such as early specialization, throwing harder at younger age, year-round play, etc.) but I don't think you can make the correlation to more fastballs meaning higher rate of TJ in these non-MLB players. The Twins and other MLB teams are starting to do some work on managing workload on an individual basis and understanding what stresses each athlete is placing on their elbow (rather than using a universal 'recipe' for every player). This is being done using Motus sleeves and other cutting edge technology (mo-cap, etc.). We are still probably in, like, mile 3 of a 26 mile marathon to understanding all of this, but we are now in a better position from a technology standpoint to make meaningful advancements. I hope we can find a way for me to do fewer TJ surgeries- especially on young players. As much as I love to operate, I'd be totally on board with a dramatic decrease in UCL reconstruction being necessary in the first place.
  8. Tom Verducci posted an article today on SI.com about Noah Syndergaard and the relationship between velocity and elbow injury. I thought it was pretty good. Also, feel free to check out my blog posts about TJ surgery decision-making and techniques, if you're interested.
  9. For those who have a subscription to the Athletic, there is a very interesting article I saw that was a deep dive into the 2019 postseason baseball, indicating that there is some evidence that the balls used in 2019 were a mix of 2019 and 2018 postseason balls. Fascinating for a baseball nerd like me. Thought some others might like it as well. Stay safe, all. heezy
  10. I haven't done 100, but I've done a fair number on appropriate candidates. I see many more teenagers than I do professional athletes in my practice, so it is definitely a good tool to have in the toolbox for this age group. Most don't have the cumulative damage to their ligament that someone who is older might. Good luck to your son! Sounds like he is progressing very well. Being diligent about the rehab is also critical, and it sounds like he has done his part. Nice job!
  11. The studies looking at injury early in the season for pitchers are often skewed IMO because they don't always account accurately for those injuries that have been simmering through the offseason. So if someone (like Sale, Severino etc.) ends up having TJ in March or April, the injury can get recorded as occurring in 'March' or 'April', when in reality it has (in most cases) occurred earlier, was being monitored in hopes that it would improve without surgery, but ultimately doesn't. So it's hard to know how to use that info when calculating injury rates. I do think the injury rate is probably higher earlier in the season, but probably not as dramatically different as some studies seem to show. For position players, I think it is likely more accurate. A very minor point about PRP- the platelets release chemical signalers called cytokines that are somewhat different from hormones. Hormones can make people think things like 'steroids' (which are naturally produced- or sometimes injected- hormones), when what PRP provides is an alphabet soup of things like TGF-beta, IGF, PDGF, VEGF and others that regulate cell activities like inflammation and healing. I just think it is important to make a distinction that injecting PRP is different from a steroid injection (whether anabolic or corticosteroid- which is a whole other discussion).
  12. http://twinsdaily.com/blog/1036/entry-11884-rich-hill-elbow-surgery-discussion/ It got a little longer than I anticipated, but hopefully you'll find it helpful. Thanks for the question!
  13. Rich Hill Elbow Surgery Discussion Heezy 1323 Happy Supposed-To-Be Opening Day everyone. Since the baseball season is (unfortunately) on hold due to the coronavirus pandemic, about the only recent baseball-related news to report has been that both Chris Sale and Noah Syndergaard (in addition to Luis Severino earlier this spring) are in need of Tommy John surgery. I covered some information about Sale’s injury and some discussion regarding techniques used in UCL reconstruction in previous blog posts. In the comment section of the latter post, TD user wabene asked an astute question about Rich Hill’s surgery and how it is similar or different from typical UCL reconstruction. Hill’s surgery is indeed different from a typical Tommy John surgery, and I thought a post about it might be interesting to some readers. As usual, my disclaimer: I am not an MLB team physician. I have not seen or examined Hill or reviewed his imaging studies. I am not speaking on behalf of the Twins or MLB. I am only planning to cover general information about this type of surgery and my take on what it might mean. Twins Daily contributor Lucas Seehafer posted an excellent article about Hill’s surgery back in January that was a good look into the surgery basics and some background about UCL primary repair. There was some additional discussion in the comments as well. Since Lucas did such a nice job covering the surgery, I won’t go into excessive detail in this post, but I’ll give my version of the basics, and then cover how Hill’s surgery is similar and different. Basics of UCL Primary Repair As covered in my post about Sale, the UCL is a strong ligament at the inside of the elbow that resists the stretching forces that occur when trying to throw a baseball. Obviously, hurling a baseball 90+ mph can take a toll on this ligament and it can, in some cases, result in a tear. These tears can occur at the top (humeral) end, bottom (ulnar) end or in the middle (called midsubstance). The figure above is from a study we did when I was in fellowship indicating the location of the ligament injury in 302 patients who had undergone surgery with Dr. Andrews. The most common areas of injury are at either end of the ligament, with the humeral end being slightly more common (at least in this series) than the ulnar end. These patients all underwent UCL reconstruction, which is the standard operation to treat these injuries when non-surgery treatments have failed to result in adequate improvement. More recently (I would say within the past 5-7 years), there has been emerging interest in performing a different operation for a subset of these patients called UCL Primary Repair. This operation differs from UCL Reconstruction in that when the repair is chosen, the injured ligament is reattached back to the bone at the site of the injury using special anchors. There is typically also a strong stitch called an ‘internal brace’ that is passed across the joint along the path of the repaired UCL as well. I often refer to this internal brace as a ‘seat belt’ stitch. The idea behind the internal brace is that early in the healing process, before it has re-developed strong attachments to the bone, the ligament is susceptible to reinjury which could cause failure to heal (or compromised strength of healing). The internal brace (theoretically) helps protect the healing ligament and allows for development of a stronger attachment back to the bone. Once healing has occurred, the internal brace is thought to act like ‘rebar’, adding some strength to the ligament (though the exact magnitude of this contribution is unclear). This figure illustrates the repair technique with the blue ‘internal brace’ also in place. This is different from UCL reconstruction, where tissue from elsewhere in the body (typically either a forearm tendon called palmaris or a hamstring tendon called gracilis) is passed through bone tunnels and used to create a ‘new’ ligament. One of the reasons for the interest in primary repair of the UCL has to do with the length of time needed for recovery from UCL reconstruction. As many of us know from having watched numerous pitchers undergo (and subsequently return from) Tommy John surgery, there is usually around 12-18 months needed for full return to pitching at the major league level. There are a number of reasons for this long time frame, but a major contributor is that this is the amount of time needed for the graft to fully heal. Recall, we are taking a tendon (which normally attaches muscle to bone) and putting it in the place of a ligament (which normally attaches one bone to another bone). Though tendons and ligaments are similar, there are differences in their microscopic structure. Over time, as the graft starts to heal and have new stresses placed on it (namely throwing), it begins to change its microscopic structure and actually becomes a ligament. In fact, there have been animal studies done that have shown that a biopsy of a sheep ACL graft (which was originally a tendon) over time evolves into what is nearly indistinguishable from a ligament. We call this process ‘ligamentization’, and it is probably the most important part of what allows the new ligament to withstand the stresses of throwing. This process, however, takes time. And because of this, the recovery from UCL reconstruction is lengthy. With primary repair of the UCL, this process of conversion of the tendon to ligament is not necessary since we are repairing the patient’s own ligament back to its normal position. Some healing is still required; namely the healing of the detached ligament back to the bone where it tore away. But this process does not typically require the same amount of time as the ligamentization process. So why, then, wouldn’t everyone who needed surgery for this injury just have a primary repair? In practice, there are a few issues that require consideration when choosing what surgery is most suitable for a particular athlete. The first brings us back to the first graph from this post regarding location of injury to the UCL. It turns out that asking an injured ligament to heal back to bone is a much different thing than asking a torn ligament to heal back to itself. Specifically, trying to heal a tear in the midsubstance of the UCL (which requires the two torn edges of the ligament to heal back together) results in a much less strong situation than a ligament healing to bone. That makes those injuries that involve the midsubstance of the UCL (about 12% in our study) not suitable for primary repair. It can only be realistically considered in those athletes who have an injury at one end of the ligament or the other. In addition, there is significant consideration given to the overall condition of the ligament. One can imagine that repairing a nearly pristine ligament that has a single area of injury (one end pulled away from the bone) is a different situation than trying to successfully repair a ligament that has a poorer overall condition. Imagine looking at a piece of rope that is suspending a swing from a tree branch- if the rope is basically brand new, but for some reason breaks at its attachment to the swing, it seems logical that reattaching the rope to the swing securely is likely to result in a well-functioning swing with less cause for concern about repeat failure. Conversely, if you examine the rope in the same situation and notice that it is thin and frayed in a number of places, but just happened to fail at its attachment to the swing, you would be much less likely to try and repair the existing rope. More likely, you would go to the store and buy a new rope to reattach the swing (analogous to reconstruction). Similarly, when we are considering surgical options, we examine the overall health of the ligament on the MRI scan, and also during the surgery to determine whether repair is suitable or whether a reconstruction is needed. If there is a significant amount of damage to the UCL on MRI, primary repair may not be presented to the athlete as an option. Also, consideration is given to the particulars of an athlete’s situation. For example, let’s say I see a high school junior pitcher who has injured his elbow during the spring season. Let’s also say that he wants to return to pitching for his senior year but has no interest in playing baseball competitively beyond high school. In this case, the athlete is trying to return relatively quickly (the next spring) and is not planning to place long term throwing stress on the UCL beyond the next season. If this athlete fails to improve without surgery (such that all agree a surgery is needed), and his MRI is favorable- he is a good candidate for UCL primary repair. This would hopefully allow him to return in a shorter time frame (6-9 months) for his senior season, which would not be possible if a reconstruction was performed. Indeed, this is the exact type of patient that first underwent this type of surgery by Dr. Jeff Dugas at American Sports Medicine Institute in Birmingham, AL. Dr. Dugas is a protégé of Dr. James Andrews and has been instrumental in pioneering the research behind UCL primary repair. As you can probably imagine, the longer players (and pitchers in particular) play baseball, the more likely it is that there is an accumulation of damage to the UCL over time. This is the factor that most commonly eliminates the option of primary repair of the UCL in many of these players. So how does any of this relate to Twins pitcher Rich Hill? Let’s discuss. Hill underwent UCL reconstruction of his left elbow in 2011. He was able to successfully return from his surgery but has certainly faced his share of injury concerns since then (as described nicely in Lucas Seehafer’s article). This past season he began to have elbow pain once again and was placed on the 60-day IL as a result. He then underwent surgery on the elbow in October 2019 by Dr. Dugas (noted above). The procedure performed was a repair procedure, but in this case instead of repairing Hill’s own UCL, the repair was performed to reattach the previously placed UCL graft. I don’t have any first-hand knowledge of Hill’s surgery, but my best guess is that the technique was very similar to what was described above for a typical primary repair with internal brace. To my knowledge, this has not been attempted before in a major league pitcher. There is data showing a relatively good return to play rate with primary repair that is very similar to UCL reconstruction. However, most UCL repair patients are much younger than Hill and the vast majority that have been studied to this point are not major league pitchers. There are a couple of ways you can interpret this data when it comes to Hill. One perspective is that he had a repair of a ‘ligament’ (his UCL graft) that was only 8 years old (since his TJ was done in 2011), and as such it likely doesn’t have as much cumulative damage as his UCL might otherwise have if he had not had any prior surgery. An opposing perspective would be that this is his second UCL operation, and even though his most recent surgery was not a reconstruction, the data that would be most applicable to him would be data regarding athletes who have undergone revision UCL reconstruction (meaning they have had a repeat TJ procedure after the UCL failed a second time). This data is less optimistic. Most studies would put the rate of return to play after normal UCL reconstruction around 85% (depending on exactly how you define successful return to play). In most studies, the rate of return to play after revision UCL reconstruction is much lower, around 60-70%. There are two MLB pitchers that I am aware of that have undergone primary repair of the UCL (Seth Maness and Jesse Hahn). Maness has yet to return to MLB and Hahn didn’t fare very well in 6 appearances in 2019. Finally, my last input on this topic as it pertains to Hill is to imagine the specific position he is/was in. He is likely nearing the end of his career (he turned 40 in March 2020). He had a significant elbow injury that was not getting better without surgery. Presumably his choices were four: 1) Continue trying to rehab without surgery and see how it goes, understanding that the possibility exists that rehab may not be successful. (Perhaps a PRP injection could be tried) 2) Retire. 3) Undergo revision UCL reconstruction with its associated 12-18 month recovery timeline, likely putting him out for all of 2020 with a possible return in 2021 at age 41. 4) Undergo this relatively new primary repair procedure with the possibility of allowing him to return to play for part of the 2020 season, but with a much less known track record. In fact, a basically completely unknown track record for his specific situation. If that doesn’t seem like a list filled with great options, it’s because it isn’t. If I’m being honest, I think Hill probably made the best choice (presuming that he still has a desire to play), even with the unknowns regarding his recovery. He obviously couldn’t have seen this virus pandemic coming, but that would seem to make the choice even better since he is not missing any games (because none are being played). For Hill’s and the Twins sake, I hope his recovery goes smoothly and he is able to return and pitch at the high level he is used to. He sure seems like a warrior and is certainly the kind of person that is easy to root for. But based on what we know about his situation, there is an element of uncertainty. If I were Hill’s surgeon, I likely would have told him that he had around a 50-60% chance to return and pitch meaningful innings after this type of surgery. Let’s hope the coin falls his way, and also that we can figure out how to best handle this virus and get everyone back to their normal way of life as soon and safely as possible. Thanks for reading. Be safe everyone. Feel free to leave any questions in the comment section.
  14. It was! Quite different, in fact. Let me see what I can put together.
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