There's seldom good news when a player is ruled out for the rest of the season. For CC Sabathia and the New York Yankees, there's actually very good news in the announcement that he'll miss the remainder of the 2014 season due to impending knee surgery, as noted by Bryan Hoch of MLB.com.
Sabathia has been out since mid-May with knee problems. He made a rehab start and had a setback. Instead of heading back to Dr. James Andrews, Sabathia checked in with several surgeons, leading many to expect Sabathia to have microfracture surgery. Instead, the Yankees announced that Sabathia will have an articular cartilage debridement, which is a cleanup and smoothing. This type of procedure is far less problematic than microfracture.
Sabathia saw several surgeons, but when it was announced he was seeing doctors that did not specialize in microfracture, such as Dr. Dick Steadman, who pioneered the procedure, there was some hope. After seeing Yankees team physician Dr. Chris Ahmad and Rangers physician Dr. Keith Meister, Sabathia chose to go with Dr. Neal ElAttrache.
All are qualified surgeons, but ElAttrache has a great track record with knees. One of ElAttrache's best known cases is not in baseball, but the return of Tom Brady after an ACL reconstruction is one of the best results we've seen. ElAttrache also put Zack Greinke's collarbone back together aggressively, getting him back on the mound quickly, and repaired Kobe Bryant's ruptured Achilles.
The normal recovery period for this type of surgery is varied. In some situations, a player could return in as little as two months, but the Yankees realize that Sabathia's size and the internal damage in his knee are significant enough that rushing him back for this season would be counterproductive. Instead, they'll focus on getting him ready for next season, much as they did with Derek Jeter late in 2013.
"Because we're in July, I think he'll come into spring training, in theory, ready to go," Yankees general manager Brian Cashman said via Hoch of MLB.com. "Given the number of things that have gone on, we'll have to be careful with him nonetheless."
The rehab for this type of operation is relatively straightforward. Sabathia will have around eight weeks of normal therapy as they focus on making sure the knee heals up well after the procedure. There will likely be a focus on making sure his secondary stabilizers are strong and that his pitching mechanics will not put an undue stress on the repaired portion of the knee.
Past that, the Yankees will focus on maintenance. Making sure Sabathia doesn't have problems between starts or at least making sure the problems are manageable will be key. Overall conditioning is not likely to be a major concern, but if any specific mechanical changes are needed, the Yankees want to give Sabathia plenty of time to adjust.
The fact that Sabathia has avoided microfracture is a major positive. While the procedure has been used for nearly 20 years in helping certain knee issues, it still has a very low percentage of success in baseball. There's really no explanation for that, but the fact remains that there are few successes. Avoiding the procedure, at least for now, gives the Yankees one less thing to worry about heading into 2015.
The best comparable situation in baseball is not a pitcher. Instead, it's Chase Utley, the Philadelphia Phillies second baseman who had two straight years of problems with damage inside his knees. The Phillies struggled to get Utley back to function, unable to find a maintenance program that would keep him on the field without significant swelling.
It took some time, but Utley has been very solid since coming back. Utley faces a different situation than Sabathia. He has less specific demands on his knees, but he has to play every day in the field. Sabathia will have the normal off time between starts, so some swelling wouldn't be devastating, though it would indicate that there are further issues.
While the Yankees can't count on having Sabathia back for 2014, they certainly have to feel better about the chance of having him take his turns in 2015. If they can get Sabathia at the top of the rotation alongside Masahiro Tanaka (who is still hoping to avoid Tommy John surgery, per Howie Kussoy of the New York Post) and keep them both healthy, they'll be a far better team.
To do so, New York's medical staff will have to overcome a lot of challenges and show better results with maintenance than it has in the past. As Mike Axisa of RiverAveBlues suggests, Cashman and the Yankees should take a hard look at their plan for 2015.
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