Tommy John surgery has become so ubiquitous and the procedure so advanced, it is largely seen as little more than a nuisance for those who don't have to endure the months of inactivity and then grueling rehabilitation.
From the outside, it seems the procedure essentially requires a pitcher sit for a year and then return to eventually throw as well as ever — and in many cases better than he did.
Jacob deGrom, Stephen Strasburg, Adam Wainwright and David Wells are among several well-known pitchers to have thrived after the surgery. Just since March 2018, 36 pitchers have had the surgery and pitched again in the majors.
In the case of Padres starter Mike Clevinger, however, there would appear to be far more uncertainty regarding how effective he will be when he returns following a second Tommy John procedure, which was performed Tuesday by Dr. Timothy Kremchek in Cincinnati.
The procedure involves a surgeon replacing the damaged ulnar collateral ligament in an elbow with a tendon from elsewhere in the body or from a cadaver. During the operation, the ligament is tightened into place via a hole drilled into the bone.
Clevinger will miss the 2021 season with an eye on a rehab of approximately 15 months until spring training in 2022 and 16 1/2 months until the scheduled start of that season. Padres General Manager A.J. Preller said Monday the expectation is Clevinger will be "able to pitch a full season in 2022 and be a starter that can go out and throw for us every five days."
While each athlete's recovery from Tommy John is somewhat unique, owing to factors that include age and experience, work ethic and plain good fortune, some reasonable tempering of expectations can be gleaned from the history of the surgery.
"On average, the typical TJ revision isn't as successful as the typical primary TJ," Dr. Andrew Cosgarea, an orthopedic surgeon and professor at the Johns Hopkins University School of Medicine, said Tuesday. "... The first time you drill a hole in the bone it is fresh and clean, but if it happens again you already have a hole there and that hole is filled with scar tissue. ... Scar tissue isn't as healthy as original tissue. It doesn't have the same blood supply; (it is) not as durable."
It could be argued there has never been a pitcher as accomplished as Clevinger who is also in the prime of his career to undergo a second Tommy John. So this is something of an unknown.
"He's got everything in his favor," said Cosgarea, who was not speaking specifically of Clevinger but in general terms regarding a pitcher of his stature and in his circumstance. "He also knows how to work hard, he knows how to rehab. He's done it before. He's got everything going for him. It's still not a slam dunk."