To Ohtani’s surgeon, a 103 mph fastball was a red flag, but his $700M deal shows trust in TJ surgery

CHICAGO (AP) — There is no one like Shohei Ohtani in the major leagues. Just last year, the two-way star took the mound and reached 103.5 mph during spring training with the Los Angeles Angels.

It was an incredible display by Ohtani after Tommy John surgery. For the surgeon who performed the 2018 procedure, who heard about the impressive session through the Angels’ staff, it was a bit alarming.

“Everybody was ecstatic,” said Dr. Neal ElAttrache, the head team physician for the Dodgers. “I was maybe the only one concerned because a jump in velocity, especially after a Tommy John operation, over the course of two to three years to that magnitude is exponentially more strain and stress on the ligament.”

ElAttrache’s concern proved prophetic, and he operated on Ohtani’s elbow again in September — this one an enhanced version of Tommy John surgery. With the 50th anniversary of the first Tommy John procedure approaching in September, ElAttrache and Ohtani are at the center of what might be the operation’s most compelling case study.

The Dodgers are betting on a successful conclusion, too. They handed a record $700 million contract to the 29-year-old Ohtani in free agency in December.

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“Fifty years after the first Tommy John and 34 years after I learned how to do the operation, now a guy’s having his second operation and he’s not only expected to come back to (his) previous level of performance, it just so happens that he’s being paid to be the best player in the history of baseball,” ElAttrache said during a telephone interview with The Associated Press, “if you consider that $700 million contract.”

“And for him to stay back, because that’s a long-term contract, guaranteed money,” he continued. “It’s remarkable the confidence that the baseball world has in this procedure at this point. And, I think, rightly so.”

Following his first Tommy John procedure, Ohtani returned to the mound in July 2020. The two-time AL MVP went 34-17 with a 2.97 ERA in 76 starts for the Angels over four seasons before he got hurt again Aug. 23 against Cincinnati.

Ohtani has dodged questions about his second elbow surgery. He said at his introductory press conference with the Dodgers in December that this operation was “completely different from my first time, so I don’t know what you want to call it. You could probably talk to my doctor about that.”

ElAttrache described Ohtani’s second operation as a hybrid procedure involving an internal brace — adding braided suture to repair the torn ligament — as well as the insertion of the tendon like what is done in a traditional Tommy John surgery.

The hybrid approach, combining the ligament replacement originated by Dr. Frank Jobe with the artificial internal brace developed by Dr. Jeffrey R. Dugas, was developed by Texas Rangers team physician Dr. Keith Meister.

“He and I are both doing the same thing, same philosophy, in adding braided suture to repair and enhance the existing torn ligament as well as putting in the new graft,” ElAttrache said. “So you’re getting all the benefits of an augmented what’s called internal brace, where you’re putting suture in to brace the elbow. I like to put that suture in the native tissue because then I know it’s perfectly anatomic and it’ll tighten at exactly the right time.”

Ohtani is the biggest name on a short list of big league pitchers who have had the hybrid procedure. One of them is Tyler Glasnow, a 6-foot-8 right-hander who signed a $136.5 million, five-year contract with the Dodgers after he was acquired in a trade.

Ohtani will be limited to hitting duties during his first season with the Dodgers, but his road back to a big league mound could include a major moment on the anniversary of the first Tommy John procedure.

“It just so happens that, if he goes along with the throwing program as we have it scheduled, he’ll be throwing his first simulated game the last week of September,” ElAttrache told the AP. “Tommy John’s operation 50 years ago was September 25th, 1974. So Ohtani will be throwing his first sim game 50 years almost to the date of the first Tommy John, which is pretty wild.”

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AP Baseball Writer Ronald Blum contributed to this report.

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