The Rays have not had a Tommy John surgery at the major league level in over five years. They are hoping that Matt Moore can avoid surgery, but after Dr. James Andrews looked at his elbow and found a sprained UCL, the hopes are slim.
The sprain is incomplete, likely below 25 percent, but a contrast MRI done at the Andrews Institute did show what orthopaedists would call a "significant sprain." At between 25 and 33 percent, depending on the doctor and the surrounding structures, the UCL is doomed to fail and rupture under new stress. At that point, doctors tend to elect to do the surgery.
Moore is now in for a couple weeks of rest, treatment and, hopefully, healing before he begins a throwing program. While most of these rehabs are not successful—it's about 12 percent—the upside of not missing a full year is enough to risk losing a few weeks.
If Moore does need the surgery, he will face the normal nine to 12 months of rehab after the surgery and should be able to return to the same level. At age 24 and signed to a long-term, team-friendly deal, Moore will have every opportunity to return, though that contract does mean that the injury will cost Moore half a million dollars.
Moore is just the latest in a long line of pitchers, becoming the 20th MLB pitcher to be diagnosed with a sprained UCL this season. Eighteen have already had surgery compared to just seven at this time in 2013 and 12 in 2012. The increase has gotten the attention of MLB, especially with the number of revision (second) Tommy Johns that we're seeing. As yet, MLB isn't doing anything about it.
For years, the Rays have been one of the most successful teams at developing pitchers and keeping them healthy. Ron Porterfield and his staff, along with pitching coach Jim Hickey, have an incredible record of pitcher health. Not only have they avoided elbow sprains, they've been able to bring in some injured pitchers and rehab them, showing no problems.
They aren't transferring the problem, either. The Rays are below league averages on all pitcher injuries over three- and five-year spans. If Moore does need Tommy John surgery, the Rays would leave the "Zero Club"—teams that have not had a Tommy John surgery in the last five years—bringing it to one single team, the Milwaukee Brewers.
That the teams with the least problems are the Rays and Brewers should surprise no one. The Rays have had a long-term focus on team health, including pitcher health, led by Dr. James Andrews and Dr. Koco Eaton.
The Brewers also have a long-term focus and are one of two teams that do biomechanical evaluations on all pitchers. Led by Roger Caplinger and Dr. William Raasch, the Brewers have shown the value of this kind of evaluation to MLB. More interestingly, the Brewers have held this record despite having multiple pitching coaches over the last five years.
The Rays also have a focused pitcher development plan that they guard jealously. Even when Jonah Keri wrote a whole book about how the team tried to find advantages, he wasn't allowed access to this part of the organization. While some pieces, like pitching 100 starts in the minors, are known, the Rays continue to refuse comment on any part of their development program.
The question now is how the Rays will deal with a failure of their system. It's clearly an isolated case, but for a team as deep into analytics as the Rays, they'll surely be checking this from every angle, especially as they try to defy the odds and get Moore back without surgery.
Is this possible? One of the world's top baseball-focused biomechanists thinks it is but that Moore has a small window to change. Angel Borrelli is a kinesiologist who has worked with a number of MLB pitchers and has focused on qualitative mechanical analysis. Borrelli is one of few biomechanists who has presented at the ASMI Injuries in Baseball course, a prestigious medical conference held once a year.
Borrelli explained that she believes Moore has to change his mechanics now in order to avoid surgery. "If that pitcher plays catch at even 45 feet and uses the set of mechanics that may have caused the situation, the throwing session will inevitably produce pain and the outcome will point to surgery."
While changing the mechanics is difficult, there are clues available. "This is where the review of the film from the injury, looking for clues, would be useful in helping the pitcher make any necessary corrections that could help the results of the 'no surgery' approach. It's actually a great time to get solid work done at a short distance," Borrelli explains.
I asked her to take a look at Moore's mechanics, and she had several notes. First, Borrelli was clear that she could only do a cursory analysis without better video than what we can find on MLB.com. "Nothing definitive can be stated, as viewing from all four sides is critical. And seeing his four-seam and his changeup from the last game would be necessary. I have been unable to find any really useful film," she told me.
Borrelli did want to have better angles on the last pitch as well. Moore injured himself on a changeup, but while the damage is likely insidious (occurring over time), the circle change was also the "pitch of record" for Stephen Strasburg and several others. This is despite biomechanical studies that show the changeup puts less force on the UCL per pitch. There's no good explanation for this as of yet.
Borrelli did note that Moore had some timing issues. "I think he is throwing both a two-seam and a four-seam. His arm is not where it should be (you will notice his foot has touched down). It is late, probably two frames late," Borrelli explains.
"When a pitcher's timing is off, he knows it, and in the process of trying to get his feel, strange things can happen, especially if an underlying issue exists. While a late arm is not necessarily a precursor, it's enough for me to want to see what he did next to make up for the late arm, which could tell the story."
The Rays are surely looking at this video and likely consulting with their own biomechanist, Dr. Glenn Fleisig of ASMI, so Moore is in good hands. Add in the quality of medical care, the depth of the pitching program and the security he has with the Rays, and Moore couldn't be in a better place, aside from the injury.
Given the long-term results of Tommy John surgery on top of the advantages Moore will have by being with the Rays in this situation, there is no reason to think that Moore can't return to the same level if he does need surgery. The Rays will try to beat the odds again and get Moore back without it. The next few weeks will be very interesting for Rays fans and for people like us who hope we can find a way to reduce pitching injuries.