Doctor: Bautista’s surgery is not routine
The 2024 playoffs were never a publicly stated return date for Orioles closer Félix Bautista in his rehabilitation from October 2023 Tommy John elbow reconstruction, but a follow-up procedure conducted Feb. 9 further cemented his eventual return for 2025, according to an orthopedic surgeon who specializes in sports-related injuries to the elbow, shoulder and knee.
Bautista, 28, underwent right elbow debridement and an ulnar nerve transposition, operations that include the removal of scar tissue and repositioning of a compressed nerve, respectively. The Orioles said in a statement that the procedure, which occurred exactly four months after his original surgery, would not alter Bautista’s recovery timeline and they still expect him to return for the 2025 season.
“About four months into his rehab, [Felix] was at a point where our medical staff and his surgeon typically make a decision about progressing into the next different phase of his rehab,” Orioles executive vice president and general manager Mike Elias said at spring training Thursday.
“At that decision point, we weren’t totally satisfied or pleased with where his range of motion was. We suspected that there was some nerve irritation sort of causing that. This is something that’s seen typically, and the doctors concurred and went in and took care of it, also removed some scar tissue while they were at it. He’s already responded very well to the surgery. It seems like his range of motion — knock on wood — it did the trick, and he’s back on track.Idonotseehistimelinehaving been altered. I think it went the way we were hoping, but it’s going to be 2025 spring training. He’s not on the radar screen for 2024, but we feel really back into place with his original 2025 timeline.”
Dr. Matthew Best, a Johns Hopkins Hospital orthopedic surgeon and director of research for sports medicine, described the pair of symptoms Bautista experienced as ailments that each affect fewer than one in five Tommy John surgery recipients.
“Sometimes people can develop scar tissue in the area of the reconstructed ligament and if that’s around the ulnar nerve, or if there is an issue with the ulnar nerve at that time, then the transposition can be performed and the debridement can be performed at that time,” Best said. “It’s not a routine thing but it can happen in certain circumstances.”
While the healing of the ulnar collateral ligament is separate from the irritation that necessitated the clean-up procedure, ulnar nerve transposition normally requires two to four months’ recovery by itself, according to Best, who is not part of the medical team treating Bautista. For the hard-throwing closer to make a complete recovery in time to contribute to the 2024 postseason, he would need to have a near-perfect rehab process.
“If you perform that surgery early on in the recovery process for a Tommy John surgery, it shouldn’t have or may not have a big impact on the total length of the recovery,” Best said. “In this case, since his initial Tommy John surgery was in October, this should cause a big delay in his total length of his recovery.”
However, Bautista said in Sarasota, Florida, on Sunday that he is still on his “original timeline” to begin throwing in early April, six months after his original procedure. Six months post-operation is the typical timeframe for when pitchers begin throwing.
“It feels really good, thank god,” Bautista said through team interpreter Brandon Quinones about his elbow after his recent operation. “It really does feel a lot better.”
Bautista said his target date is still opening day 2025, but “if I’m feeling good and everything is looking well for me to come back before that, then we’ll see.”
This year’s playoffs was always a long shot for Bautista. The right-hander suffered the partial tear of his UCL while throwing a 102 mph fastball Aug. 25; the established timeline for MLB pitchers completing Tommy John rehabilitation is anywhere between 12 and 18 months. Baltimore put surgery off at first with hopes that rest would provide enough healing for him to pitch with the partial tear. He worked up to a live bullpen session over the following weeks but was shut down by Sept. 30.
“Mathematically, there might be, but it’s unusual, and I definitely don’t want to send that expectation out there, and we’re also not going to want to rush him,” Elias said in September of Bautista potentially returning in time for the 2024 playoffs.
“I think there would be some risk in artificially pushing for the end of next season. If it happens, great, but I would say odds are that we’re going to want to use the wintertime and just get him really right for 2025.”
Opening day 2025 will be more than 18 months removed from Bautista’s original surgery date, giving him ample time to recover in time to reassume closer duties for Baltimore. The Orioles moved him to the 60-day injured list on Wednesday in anticipation of him missing the entire year. It would take an uncharacteristically rapid healing process for that roster status to change at all in 2024.
Baltimore Sun reporter Jacob Calvin Meyer contributed to this article from Sarasota, Florida.
Orioles closer Félix Bautista, center, is expected to be ready for the 2025 season.