The most important question facing Shohei Ohtani could ultimately be this: How important is it to him to continue as a two-way star? Because if Ohtani opts for Tommy John surgery to repair the torn ligament in his throwing elbow, his best chance to return as a top-flight pitcher could come at a short-term cost.
Long term? He might be best off skipping the 2024 season altogether.
If Ohtani elects Tommy John as he approaches the most anticipated free agency in MLB history, orthopedic surgeons believe he could return in time to contribute next season exclusively as a hitter. But those doctors also told The Athletic that doing so could add risk to his rehab process as a pitcher, which is made more complicated since this would be Ohtani’s second elbow-ligament reconstruction.
“If you said, ‘What is the best way to make him a pitcher?’ It would be to avoid disruption of his progression and throwing (in his rehab),” said Dr. Chris Ahmad, the Yankees’ head physician who has performed Tommy John surgeries on other major leaguers.
No matter what rehab path Ohtani chooses, in the event he does have Tommy John, he’s most likely not pitching again until the 2025 season.
“No way he pitches in 2024,” Dr. Chris Geary, an orthopedic surgeon at Brockton Hospital in Massachusetts, said of a scenario where Ohtani goes for the surgery. Geary and Ahmad spoke to The Athletic as medical experts, and are not treating Ohtani.
What complicates matters is Ohtani’s prowess at the plate. In his age-29 season, he likely could still be a premier hitter if he returned as a DH sometime next year, following a blueprint established this season by Bryce Harper.
“If he’s doing the Bryce Harper thing where he’s DH’ing and playing some occasional first base, I would be shocked if he wasn’t back by June,” Geary said. “That’s a longer timeline than Harper.”
At least for now, Ohtani is continuing to DH this season, The Athletic’s Sam Blum confirmed.
When Ohtani went for his first Tommy John surgery, in October 2018, he had 425 plate appearances as a DH the following season. But choosing to once again play as a hitter while also juggling rehab could add more complications to a process that is already risky.
“Very little precedent for his situation,” Geary said. “Like, none.”
Second Tommy John operations — revisions, as they’re called — have a lower success rate than the first. Playing in any capacity in 2024 would likely mean interrupting, or otherwise greatly revising, a typical recovery schedule.
“There will be some compromise to his rehab process if he becomes a position player, depending on what his workload is, if he comes back next year,” said Ahmad. “Especially in a revision second-time Tommy John, you want the rehab to go perfectly. And the rehab, by design, that throwing progression, it’s designed to have very strategic incremental building loads on the ligament, so that it gets stronger and stronger during that lengthy rehab time.
“For a second-time surgery — especially for a hard thrower who is effective, who has a lot of career left — you would like to see that rehab process go through smoothly with a dedication to the progression. Having said that, it’s not impossible to do (rehab differently). It just means that you have to build in the strategy to have a throwing progression, and that certainly would take place in the offseason and during the following spring.”
Ohtani says very little of interest publicly, but one of the things he has talked about repeatedly is his desire to win. Naturally, not playing next season to focus on his rehab as a pitcher would mean sacrificing an attempt at a ring, in his prime, no less. That’s a hard thing for anyone to do, particularly for someone who could still be a massive difference maker — but it’s also totally understandable given what might be at stake in the long run.
Now, we don’t know yet, but it’s conceivable Ohtani himself might not consider this much of a decision. His dual roles thus far are intrinsic to his legacy, to his otherworldly position in the sport and its history. Why wouldn’t he do all he could to pitch again? Unicorns don’t typically decide one day, “You know what? I think I would prefer to no longer be a unicorn.”
No matter what, a lot of factors are at play.
Ohtani’s approach could affect the money offered to him in the winter, or at least, the teams most interested in him. Losing an entire year of the best player in baseball amounts to more than peanuts, and you can be sure front offices are counting every bean and legume. But, an unconventional approach to the rehab could make a team devalue its long-term projection for Ohtani as a pitcher, and maybe even as a hitter too, adjusting for the risk.
Now, might Ohtani be able to avoid Tommy John entirely? Unless the injury is really mild, or unless Ohtani was content to DH full-time on a more permanent basis, the doctors believed it would be difficult for him to return to full form without it.
“It depends on some factors, and that’s the severity of the injury, and location of where the injured ligament was,” Ahmad said when asked about potential alternatives. “Because there are some non-operative choices besides surgery, and we’ve used PRP (platelet-rich plasma injections) in the past with some success. But it has to be a very mild injury.
“The way modern baseball is played now, infielders, outfielders throw with max effort. They just don’t have the same amount of repetitions (as pitchers).”
A new procedure, internal bracing, has also gained popularity, and it can be done in conjunction with or separately from Tommy John surgery.
“If that tear is in a very focal location … you don’t have to re-take out the whole engine and replace it,” Ahmad said. “You can just correct the broken parts.”
But it wouldn’t work in all situations.
“If the tear pattern is such that the whole ligament is damaged — it’s not focal, it’s a diffused tear — they’re not a candidate for it, and they would have a better success rate with a revision Tommy John,” said Ahmad, who in 2016 performed Nathan Eovaldi’s revision. Eovaldi subsequently made two All-Star teams.
Ahmad noted that sometimes players can change the force they put on the elbow to avoid surgery. In an extreme example, someone could become a knuckleball pitcher, he pointed out.
That might be the only intrigue Ohtani’s offseason does not hold.
“Ohtani is an extremely unique player and there is not a sample size to guide and govern what would be the ideal boundaries for safety for him,” Ahmad said. “Every option should be discussed, because it’s unique. And then after you discuss it, that’s where decisions become more clear. Maybe it just doesn’t make sense for him to (hit in 2024), because of his desire to be a pitcher, and he still has lots of baseball ahead of him.”
(Top photo: Mark Cunningham / MLB Photos via Getty Images)