Ask BA: How Bad Is A Second Tommy John Surgery For A Pitcher?

The recent surge of Tommy John surgeries is being talked about all around baseball, and it’s the subject of this week’s Ask BA question. As always, if you have a question for Ask BA, send it to and please include your full name and hometown.

Q:With Jarrod Parker now having his second Tommy John surgery, what is the general prognosis for pitchers having second (or more) surgeries? All I have ever heard is, ‘it’s not good,’ but I’ve never heard it more deeply discussed.

Mike Volberding

BA:Mike, two-time Tommy John survivors are more common than you may believe. Among the current two-time TJ recipients are current Yankees' closer Shawn Kelley, Rangers closer Joakim Soria, Dodgers setup man Brian Wilson and Red Sox reliever Chris Capuano.

Jon Roegele's invaluable list of Tommy John recipients found 46 players who had two or more Tommy John surgeries. Three were position players, which isn’t all that germane to your question. Another 10 were pitchers who have not had a chance to work back from their second surgeries yet, but of the others, 26 made it back to the big leagues while seven did not. That 78.7 percent success rate compares pretty favorably with the percentages of pitchers who make it back from a first Tommy John surgery, especially when you add in the fact that a few of the pitchers who didn’t make it back were fringe big leaguers pre-injury.

Brian Wilson (Photo by Bill Mitchell).

Brian Wilson (Photo by Bill Mitchell).

Parker is joined by Braves' starters Kris Medlen and Brandon Beachy, Astros reliever Peter Moylan, Diamondbacks' starter Daniel Hudson and Padres starter Cory Luebke among pitchers who are currently rehabbing from their second Tommy John surgery.

Going through a second Tommy John surgery is a mentally draining experience. Any Tommy John surgery involves a painful rehabilitation that takes roughly a year, but players who have gone through it have described it as even more challenging mentally. Rehabbing pitchers are generally separated from their teammates, usually rehabbing at the club's Arizona or Florida complex. There's the slow progression as pitchers first work back to being able to throw, then they have to slowly work up to throwing off a mound and then they have to relearn how to hit spots as they could before the surgery.

It's rough enough the first time, but when a pitcher re-injures his elbow ligament, he already knows how difficult a rehab it will be, which makes it even more taxing.

But the good news for pitchers is that there are plenty of examples of pitchers making it back from a second Tommy John surgery. And generally they are coming back from the second surgery with roughly the same stuff that they had.

In Soria's case, he's lost roughly a mile per hour off of his fastball compared to what he was throwing before his second surgery. Wilson's velocity last year was roughly equal to what it was in 2012 before his second surgery, but that was a 1-mph dip from his 2011 average velocity.

Kelley's velocity dipped in his first year back, but it has since returned to what it was before his second TJ. Capuano returned from the second surgery throwing harder than he was pre-injury. Nowadays he's throwing 3-mph harder than he was before he was cut.

So for Parker, Medlen, Beachy and the other two-time TJ men working toward becoming two-time TJ survivors, the prognosis doesn't seem all that different than that of a typical Tommy John surgery recipient. With more and more pitchers undergoing the surgery in high school or early in their college or pro careers, it's likely we'll see even more two-time surgery survivors going forward.

But for now righthander Jason Isringhausen still stands out with an unwanted crown—he's a three-time Tommy John surgery survivor. That's an award no one wants to earn.