Pitchers finding ways to skirt elbow surgery
whose injuries fit a certain profile.
Maness, 28, spent four seasons pitching out of the St. Louis Cardinals bullpen and signed a minor league contract with the Kansas City Royals in February. Maness’ ligament had pulled away from the bone rather than tearing across the middle. Instead of needing a full Tommy John surgery, which requires grafting a tendon from the wrist or hamstring into the elbow to replace the UCL and at least a year of recovery, Maness was a candidate for a primary repair.
“Really this primary brace technology … had been used more widely in Europe, particularly for ligament injuries of the knee and the ankle,” said Dr. George Paletta, St. Louis Cardinals head orthopedic surgeon who performed Maness’ surgery. “So the concept or the idea was, OK, it’s working well there, is there a way to adapt it to the elbow?”
Paletta had done roughly 60 primary repairs on amateur pitchers prior to operating on Maness and saw an average recovery time of 6½ months. That background helped him establish three criteria — he needed a young pitcher, an otherwise healthy ligament and, most importantly, the ligament needed to pull off the bone on one end rather than tear in the middle.
“We’ve had a lot of experience with ligaments healing directly to bone and we have a good understanding of that timetable, so we knew that by about 12 weeks after surgery, this repair should be pretty well healed and pretty solid at that point,” Paletta said.
Cardinals reliever Mitch Harris also had the primary repair, as did a third pitcher with major league experience, according to the St. Louis Post-Dispatch, with whom Maness first discussed the procedure in January. Cardinals non-roster outfielder/pitcher Jordan Schafer had the procedure this month.
The UCL in Richards’ right elbow had a tear running along the ligament, not across it. He sought second opinions from noted orthopedic surgeons Dr. James Andrews and Dr. Neal ElAttrache.
“Dr. Andrews pretty much told me, ‘Hey Garrett, if you were my son, I would try the stem cell first,’” Richards said.
Doctors removed stem cells from his pelvis and injected them into his elbow, in hopes the cells would heal the UCL. Stem cells, extracted from bone marrow, are able to develop into multiple different tissues and can promote healing.
“It just feels tight. You’re putting fluid into a place that pretty much doesn’t have any room for any more fluid,” Richards said of the injection. “If you can imagine you’re just overfilling a certain area with this nice special sauce.”
Teams sometimes use platelet-rich plasma injections, where blood is spun in a centrifuge to isolate growth factors — Takashi Saito’s PRP injection in 2008 was believed to be the first for a major league pitcher, and Masahiro Tanaka also has pitched successfully with a partially torn UCL after PRP treatment — but stem cells are less common. Bartolo Colon, soldiering into his 20th major league season at 43 years old, had a stem cell treatment in 2010. Boston Red Sox left-hander Drew Pomeranz had a stem cell injection in his elbow this winter to address lingering soreness. But Pomeranz went on the disabled list Thursday with left forearm flexor strain.
It doesn’t always work. Richards’ teammate, lefty Andrew Heaney, needed Tommy John last summer after stem cells didn’t do the trick.
Richards’ six-week exam showed significant growth. His three-month check showed even more. He reported no issues this spring, his high-90s mph fastball is back and he is on track to open the season in the rotation.
“Everything feels great,” Richards said. “… Basically I took the year off, let my arm heal and now I’m back doing what I always do. I just feel refreshed.”