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Thread: A potential alternative to Tommy John that could cut recovery time in half

  1. #1
    All Star TwistedLogic's Avatar
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    A potential alternative to Tommy John that could cut recovery time in half


    Maness a trailblazer? New surgery for elbow repair cut recovery time
    By Derrick Goold, St. Louis Post-Dispatch - 2 hrs ago


    Former St. Louis Cardinals relief pitcher and current free agent Seth Maness works through a throwing routine at John
    Burroughs High School in Ladue on Friday, Jan. 6, 2017. Maness is recovering from elbow surgery that ended his season last
    year. The seams on the balls Maness threw whistled as they traveled 90 feet away to Cardinals second baseman Kolten Wong
    who was playing catch with Maness. Photo by David Carson, dcarson@post-dispatch.com


    When Seth Maness shut his eyes before a surgeon opened his right elbow, the former Cardinals
    reliever was not sure what awaited him on the other side of sleep. The troublesome ligament in
    his throwing arm had to be fixed and a complete reconstruction would mean missing an entire
    season.

    He went under unsure.

    He woke up a potential trailblazer.

    Maness is a week away from returning to the mound and expects to be ready for opening day,
    just 7½ months after surgery, because Dr. George Paletta performed a repair that could
    eventually prove to be an alternative to Tommy John surgery for select big-league pitchers.
    Until the St. Louis-based orthopedic surgeon saw inside Maness’ elbow, he wasn’t sure if Maness
    was a candidate to be the first established major-league pitcher to receive the new procedure,
    Paletta said.

    Now, the doctor and his patient are eager to watch as Maness’ first time toeing the rubber could
    be, in their words, “a significant step forward” for the industry. Another doctor who performs
    the repair surgery, Dr. Jeffrey Dugas, said there is “cautious optimism.”

    “It was a game-time decision,” said Maness, a free agent. “I’m going into it sort of expecting
    Tommy John and hoping for the other one. You go from looking at missing a whole season to
    possibly being back at the start of the year — that’s a big relief. When Dr. Paletta told me, it
    was like this little ray of light: There’s a chance.”

    Maness, 28, completed three sets of throws at a distance of 90 feet on Friday in the John
    Burroughs School gymnasium. He is scheduled to take the mound next week for the first time
    since his Aug. 18 surgery. He has been encouraged by how his arm feels at every stride in his
    rehab, which is accelerated from the usual Tommy John timetable. The Cardinals did not offer
    him a contract in early December, making him a free agent — one of the leading groundball
    relievers now available to any team. Sooner than expected.

    The surgery Maness had, called “primary repair,” doesn’t have the sexy name. It doesn’t have
    the brand recognition of Tommy John. But it also doesn’t have the lengthy recovery time of its
    famous forefather. It is a repair and buttressing of the existing ligament at the bone, not Tommy
    John’s reconstruction of the ligament. The scar Maness has on the inside of his right elbow is the
    familiar arc of a Tommy John recipient. (Two of the Cardinals’ five starting pitchers have the
    same scar.) And the medical code assigned by Major League Baseball to Maness’ profile for
    interested teams is the same as Tommy John. As a result, so are the assumptions about the
    righthander’s availability for 2017. The surgery he had is too new to have its own code.

    “It has that potential to be big,” Paletta said.

    “People are watching this and it’s an interesting thing for all of us,” said Dugas, a managing
    partner at the Andrews Sports Medicine & Orthopedic Center in Birmingham, Ala. “There is a lot
    that we need to learn from Seth, a lot that we need to learn from all of the guys (who have had
    it). We need the data. There are still so many hurdles to go over, but we’re excited to watch
    what is going to happen because of what is possible. We’re going to follow him very closely.”

    “Everyone in baseball should be following this,” said Jeff Berry, Maness’ agent and co-head of
    CAA baseball. “He was an outstanding major-league reliever. He was hurt in 2016, was never
    right. He has this surgery and he needed the ligament repaired, but he’ll be ready for spring
    training, not out for the entire season. Imagine that. Think about the economic impact that has
    for the game. Think about what it means to his career.”

    "Scary Little Thing"

    Tommy John, pioneered by Dr. Frank Jobe and named for the first big leaguer to receive it, is a
    complete reconstruction of the ulnar collateral ligament using a graft. Since its first use, in 1974,
    Tommy John has been improved but remained largely unchanged as it became the industry
    standard for treating tears of the UCL. The year absence required for rehab has become as
    familiar and commonplace in baseball as the one-inning closer and interleague play.

    Major League Baseball has been unnerved in recent years by a spike in Tommy John surgeries.
    By 2015, the proliferation of Tommy John, or TJS, was referred to as an “epidemic,” and
    baseball commissioned a study to understand why the rate of elbow injuries had increased at all
    levels the game is played, including high school. In 2014, 31 major-league pitchers had UCL
    reconstruction – twice as many as the average from the previous decade. Its ubiquity in the
    game led to misconceptions, prompting the American Sports Medicine Institute to stress how
    “10 percent to 20 percent of pitchers never make it back to their previous level after Tommy
    John surgery.”

    Major-league pitchers know this reality well.

    They sense it with every twinge.

    “It’s that scary little thing. It’s always in the back of your head,” Maness said. “You know
    anything in that area and automatically you want to avoid assuming any elbow pain is it.
    Because, oh man, it’s a career. Today, it’s not a career-ender, but really for a reliever it throws
    a little wrench into the scheme of things. I’m expendable. Things can happen.”

    Paletta, a partner at The Orthopedic Center of St. Louis, is one of the nation’s leading Tommy
    John surgeons, with around 600 performed. He has done many of the Cardinals’ elbow
    reconstruction surgeries of this era, and this winter the team announced that he would return
    as its Head Orthopedic Physician. That came a few months after Maness’ surgery. Maness gave
    Paletta permission to speak to the Post-Dispatch about the specifics of his surgery.

    "The Right Pitcher"

    About two years ago, Paletta also started doing the “primary repair” option for elbow injuries
    that qualified. He has performed more than 50 of these surgeries, and he is working on a paper
    about his findings. There have been no failures, he said. Dugas, at Dr. James Andrews’ practice,
    performed his first “UCL repair with internal brace construction” in August 2013. Dugas has
    done around 150 of these surgeries and does not know of one that had to be redone or led to
    Tommy John.

    For both surgeons, the average time of recovery has been 6½ months instead of Tommy John’s
    12 months or more. Paletta said 32 of the pitchers who he helped with a “primary repair”
    surgery have now pitched two seasons since the procedure.

    Mitch Harris and Maness are two of the three pitchers with major-league experience who
    qualified for and received the alternative procedure. Dugas described how the surgery has
    advanced cautiously from prep players to college players and for it to make this next leap to a
    major-league pitcher “it has to be the right pitcher, the right situation.”

    “In select cases of UCL tears, with this technique, they have the real potential to not miss the
    next year,” Paletta said. “This is potentially a huge stride forward in three ways. First, early
    results show a high success rate. Second, a return to play is cut by 40 percent. That’s a huge
    factor. We are able to accelerate the return-to-throwing (rehab) program for the athletes. With
    this technique at the end of 2016 we have a pitcher who is ready to pitch in games by opening
    day.

    “And the third way,” Paletta continued, “as a consequence of this, in the right setting, one would
    feel more confident moving to surgery early on.”

    Paletta had to see during surgery the condition of Maness’ ligament before being certain he did
    not need complete reconstruction. The integrity of the tissue is essential, and sometimes a big-
    league pitcher’s aged and worn ligament can be as solid as wet toilet paper. The location of the
    tear is also an indicator for “primary repair.” A rupture in the middle of the ligament requires
    Tommy John. But if the tear is at either end of the ligament, where it attaches to a bone, then
    the “primary repair” is possible.

    The “UCL repair with internal brace construction” – its full clunky name – begins with repairing
    the ligament and anchoring to the bone. A bracing system is then constructed out of tape to
    help promote healing in the area. That’s the recent advancement, one made possible by Arthrex
    tape. Paletta said he and others are borrowing from procedures used to repair ankles and knees
    to address an injury in the elbow. The clear benefit of this “primary repair” is that it addresses
    the native ligament, and thus doesn’t require a graft and the time that takes for a rebuilt
    ligament to assimilate.

    “We’re repairing the existing ligament and reinforcing it with a scaffold that provides increased
    strength for healing from time zero,” Paletta said. “From the get-go.”

    That also allows for a quicker return to pitching.

    "The Maness"

    Three weeks ago, Paletta cleared Maness to begin throwing. For Tommy John pitchers, the long
    toss program is eight to 10 weeks. For Maness, it was four. Tommy John pitchers won’t begin
    their throwing program until five months or more after surgery; Maness started four months
    after surgery. Lance Lynn missed all of last season recovering from November 2015 Tommy
    John surgery, and he and Maness are both expected for opening day.

    From 2013-15, Maness was one of the leading strike-throwing relievers in the majors. Of the
    178 relievers in that time who had at least 100 appearances, Maness ranked seventh in walk
    rate (4.4 percent) and third in double-play rate (12.91 percent). He led all relievers by stranding
    144 of the 215 runners he inherited.

    The next closest was 91.

    Throughout 2016, however he felt his arm sag and his results follow. He watched “as my game
    just slowly fizzled away,” Maness said, and blamed his mechanics until the damage in his right
    elbow was discovered. Paletta outlined several options for him – and one was the dreaded
    Tommy John, the vaporization of a year, and the uncertain future. The other was a mouthful, a
    surgery that didn’t have the snappy name but offered the possibility of a quicker return.

    With each throw, Maness is helping baseball study the new technique’s potential.

    It just needs a catchier name.

    “Does he need Tommy John,” Berry suggested, “or a Maness?”

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    I did my Clinical Biomechanics final project on TJS. This is an awesome post! Thank you.

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    DONOR | Super Moderator G-Snarls's Avatar
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    Damn

    Nice

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    DONOR | Super Moderator G-Snarls's Avatar
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    Masahiro Tanaka next test case

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    Big Leaguer Pendleton's Avatar
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    Neat, here's hoping Maness turns out to be a success.

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    TL is on fire...

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    All Star TwistedLogic's Avatar
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    Quote Originally Posted by G-Snarls View Post
    Masahiro Tanaka next test case
    That's exactly who I was thinking of when I read this. Seems like the perfect candidate for it. Yanks should have put him under the knife last year. Wasted recovery time in a rebuilding year.

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    Tanaka can opt out after this coming season, right? Can't see him doing it now. Should have done it last year.

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    DONOR | Super Moderator G-Snarls's Avatar
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    Quote Originally Posted by Pendleton View Post
    Neat, here's hoping Maness turns out to be a success.
    I hope so

    Would be great for him and the game

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    DONOR | Super Moderator G-Snarls's Avatar
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    Quote Originally Posted by TwistedLogic View Post
    That's exactly who I was thinking of when I read this. Seems like the perfect candidate for it. Yanks should have put him under the knife last year. Wasted recovery time in a rebuilding year.
    Sounds like the right type of tear too. Partial tear that can be rebuilt before the whole thing ruptures and TJS is the only option

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    DONOR | Super Moderator G-Snarls's Avatar
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    It seems Matt Harvey might have been well suited for this too

    Too late now

    I wonder if he knew about this?? Was it considered?
    Last edited by G-Snarls; 01-11-2017 at 03:23 PM.

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    DONOR P2F's Avatar
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    Quote Originally Posted by G-Snarls View Post
    It seems Matt Harvey might have been well suited for this too

    Too late now

    I wonder if he knew about this?? Was it considered?
    Harvey has TOS. I haven't read the article yet, but I'm assuming this wouldn't apply to him if it's geared towards TJ.

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    Relevant:

    http://www.fanragsports.com/mlb/garr...s-2017-season/

    "Last season, the Angels struggled with both offensive production — despite Trout’s presence — and pitching injuries — losing Richards and Andrew Heaney to elbow ligament tears. While Heaney went on to have Tommy John surgery and will miss the entirety of the 2017 season, Richards has seen some success with an innovative stem-cell therapy program aimed at repairing or bolstering the ligament without the need for straight-up replacement. Per recent reports, Richards is throwing again, and will be ready for Spring Training and beyond.

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    Top 100 Prospect TholesWeirdEye's Avatar
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    This article got my dick hard.

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    Big Leaguer Frag's Avatar
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    Seth Maness surgery has a nice ring to it.

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    All Star TwistedLogic's Avatar
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    Quote Originally Posted by Frag View Post
    Seth Maness surgery has a nice ring to it.
    "The Maness Procedure"

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