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    HomeSportShohei Ohtani’s elbow injury: Six questions that will shape what comes next

    Shohei Ohtani’s elbow injury: Six questions that will shape what comes next

    The initial news reverberated through the sport like a shockwave. Shohei Ohtani, this unthinkable unicorn pushing baseball beyond its preconceived limits, was hurt.

    And then, the questions started coming. Ohtani, now with a tear in the UCL of his pitching elbow, is months away from becoming a free agent. What does it mean for his market, his destination, his future?

    There’s still a lot to learn, and much no one can answer right now. Some answers might not even be known yet to Ohtani himself. But at least a few answers will arrive in time.

    Here’s what’s top of mind in the immediate aftermath:


    How committed is Ohtani to remaining a two-way player?

    Ohtani has yet to speak publicly since the UCL tear, but history tells us he’s likely to do everything in his power to continue both pitching and hitting. Ohtani once desired to come to the big leagues out of high school. Had that happened, he might never have become the two-way player we know today. Ohtani ultimately stayed in Japan and thrived as a pitcher and hitter with the Nippon-Ham Fighters.

    Even after Ohtani came to the U.S. and had Tommy John surgery in 2018, he rehabbed and went on to do things never before seen in Major League Baseball.

    “Ideally, if it comes down to them telling me to just focus on hitting or focus on one thing pitching, I will listen,” Ohtani said in 2020. “But ideally, I would like to leave the window open for me to do both.

    “If the possibility is there, I still want to try (pitching). The Angels signed me thinking I’m going to be a two-way player. I just need to get healthy, back on the mound and try to accomplish it.”

    Another injury and the potential of another surgery could muddy the waters. But given everything we have seen from Ohtani, it is difficult to imagine a world where he does not again try to defy every preconceived notion for what is possible. — Cody Stavenhagen

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    Can he hit in 2024 and still rehab his elbow?

    Shohei Ohtani can still hit, but at what cost? (Harry How / Getty Images)

    If Ohtani really does want to keep pitching at his best, then he’d likely be rolling the dice if he decides to try to hit in 2024.

    A presumptive second Tommy John surgery is a bit of a dice roll to begin with. But hitting in 2024, even just as a DH, and veering off the prescribed routine for rehab, could lessen the odds he gets back to his full form as a pitcher as he wants to. The operative word becomes “risk.”

    “There will be some compromise to his rehab process if he becomes a position player, depending on what his workload is, if he comes back next year,” said Dr. Chris Ahmad, the Yankees’ team physician and a surgeon who has performed Tommy John operations. “Especially in a revision second-time Tommy John, you want the rehab to go perfectly.”

    Time is required and the rehab process is necessarily slow. Ahmad used the analogy of rubbing one’s hand against sharp gravel: At first, it would cause bleeding. But building it up gradually over time creates strength in the skin of the hand; it’s much the same for the ligament.

    At the same time, Ahmad pointed out, “It’s not impossible to do it, it just means that you have to build in the strategy to have a throwing progression, and that certainly would take place in the offseason and during the following spring.” — Evan Drellich

    How does this impact Ohtani’s free-agent market?

    This is the million … err, $800 million … question. The first point here: Even if Ohtani is only a hitter, he would still be the most desirable free agent in this offseason’s class. This is a player who has 44 home runs and an overall offensive output that ranks 81 percent above league average. He could be in for a massive payday even if he is only half the player we have come to know. The Athletic’s Ken Rosenthal wrote Ohtani could still be worth $500 million as a hitter alone.

    At least some decision-makers in the game were already considering the reality that Ohtani might not be able to pitch full-time for the duration of whatever megadeal he received.

    “His injury actually brings a degree of clarity to his free agency,” Rosenthal wrote. “The team that signs Ohtani will pay him as a hitter. Anything he provides as a pitcher will be a bonus.”

    For comparison, Aaron Judge received a nine-year, $360 million contract this past offseason. Ohtani stands a strong chance of surpassing that total. A deal full of opt-outs and incentives could be one way of offsetting the current state of uncertainty. The injury could give the Angels a small dose of hope at retaining Ohtani, but it is unlikely to keep big spenders such as the Mets or Dodgers away. If anything, a slightly more realistic price tag could mean more teams in the bidding for Ohtani, not fewer. — Cody Stavenhagen

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    Would it make sense to take a one-year deal?

    It could make sense for Ohtani to sign some short-term contract in the hopes of re-establishing a level of clarity heading into free agency again in one or two seasons. This would, of course, be a massive risk for Ohtani. And there are, perhaps, more reasons against it than for it.

    There is some belief that Ohtani will look to make a deal like this and bet on himself. The downside is that he’ll then be on the other side of 30 years old. And the true incentive for teams to sign massive mega-contracts is that they’ll get the first couple years of a player in their prime, while accepting that they’ll overpay for a player’s decline years as a result.

    There’s also the inherent reality that he won’t come back to pitch in 2024, so there’s not going to be any certainty heading into another contract season. The flip side would be that Ohtani would have a fresher arm at around 31 or 32 years old. The question would be if it’s enough to offset what he’d make by signing a lucrative long-term contract this year.

    Ohtani lost out on possibly hundreds of millions of dollars with this horribly-timed injury. He’ll still command a massive salary regardless, and it’s possible neither option will get him back to what he would have made. — Sam Blum

    Why did the Angels allow him to pitch after his recent bout of arm fatigue?

    Shohei Ohtani leaves the mound during Wednesday’s game. (Ronald Martinez / Getty Images)

    The Angels are of the belief that Ohtani wouldn’t have been able to pitch the 1 1/3 innings that he did on Wednesday with a tear in his UCL. He also threw a bullpen the day prior, which the team says was without issue. That means they believe it’s almost certain that he suffered the tear while pitching on Wednesday. That said, it is certainly fair to be curious about the Angels’ process here.

    Ohtani had already skipped his previous start with arm fatigue. And no imaging was done on his arm after his last start because Ohtani had not complained about anything beyond fatigue. There wasn’t concern about an injury — just that he was tired.

    But clearly, something was not right in his last start. His fastball velocity was down 3.7 mph and his sweeper velocity was down 4 mph. Everything was down. Something was wrong.

    To understand the Angels’ thinking, it’s important to understand the broader strategy with Ohtani. He has almost complete autonomy in everything he does. He trains on his schedule. He plays when he wants to play. He pitches when he wants to pitch. So him starting on Wednesday is more a reflection of that. They trusted him to go out there because he said he could, even if there were some possible red flags about doing so.

    It’s hard to say what, if anything, would be different if he didn’t start on Wednesday. Or he’d gotten imaging before the start. But it seems very unlikely the arm fatigue he’d dealt with in recent weeks is completely divorced from the much more serious injury he’s now dealing with. — Sam Blum

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    How successful are pitchers returning from a second Tommy John Surgery?

    Anecdotally, rather successful. Daniel Hudson threw the final pitch of the World Series six years after his second Tommy John surgery. After their respective Tommy John revisions, Nathan Eovaldi turned into an All-Star starter; Jameson Taillon signed a $68 million free-agent deal; Joakim Soria, Kirby Yates and Justin Topa developed into valuable relievers; and, if we’re into extracting meaning from tiny samples, Hyun Jin Ryu has a 1.89 ERA in four starts. There are also many examples of pitchers who didn’t return to form after a second Tommy John surgery, for various reasons, but the simple answer is that a revision is not a death sentence for a career.

    An even simpler — yet far more disappointing — answer is we’ll know much more about the success rate of Tommy John revisions in a few more years as the list of two- (and three-) time Tommy John guys grows. You could build a star-studded, playoff-caliber rotation of starters currently working their way back from a second Tommy John: Jacob deGrom, Shane McClanahan, Walker Buehler, Dustin May, Chris Paddack, Joe Ross and now, perhaps, Ohtani.

    While the success rate of first-time Tommy John surgeries is very good, not much literature exists examining the success rate of Tommy John revisions. A 2016 study found that about 40 percent of MLB pitchers who’d had a Tommy John revision since 1999 had returned to pitch at least 10 more games in the majors, while a 2020 study found that half of players (the study included 38 pitchers and two position players) returned to their previous levels of competition. The more Tommy John revisions are performed, the better the data and our understanding of the success rates will be — but, as with everything related to Tommy John surgeries, it’ll take time. — Stephen J. Nesbitt

    (With reports from Evan Drellich and Stephen J. Nesbitt) 

    (Top photo: Ronald Martinez / Getty Images)

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