Red Sox pitcher Chris Sale should get elbow surgery ASAP

With more coronavirus-related delays to the 2020 MLB season seemingly inevitable, the more Red Sox pitcher Chris Sale benefits from immediate elbow surgery.

I don’t believe in crystal balls or tarot cards, but I trust my gut, and it tells me that Boston Red Sox pitcher Chris Sale should go ahead and get whatever surgery he needs for his pitching elbow. Allowing myself a bit of speculation, I expect that MLB Commissioner Rob Manfred, by the end of March (if not sooner) is going to cancel the entire 2020 season based on what we are now hearing out of Washington, D.C. about the coronavirus pandemic.

President Donald Trump said Monday that the coronavirus outbreak and more stringent American lifestyle guidelines could last into July or August, although federal health experts suggested shorter-term guidelines, at least at this point. Whether or not you have fans in the seats, mid-July or later is too late to start even a significantly abbreviated season.

Call 2020 a lost season for Sale so he can get a surgical head start on being ready for as much of the 2021 season as is medically possible. Note, though, according to the Boston Globe, that Sale has recently commenced throwing again in Fort Myers, testing his arm out to see how it responds.

Right now, as I write this – and outbreak-related timelines change by the day – Manfred has pushed the start of the 2020 season to the latter half of May, two months from now. That puts a second spring training five or six weeks away. Yet, the pandemic has the look and feel of a Star Trek-like cloud creature determined to continue growing and spreading at least that long.

If I’m Manfred, my best-case scenario is an 81-game season – exactly half a traditional regular season – that would launch on or around July 1, with teams reporting to Spring Training Part II the first week of June. Or maybe you start the season, symbolically, on June 20, the first official day of summer to welcome back “the boys of summer.” Better yet, start it on July 4: Independence Day, as we celebrate the return of America’s pastime simultaneous to (hopefully) our emergence from a pandemic that has gripped the nation with a mix of fear and dread.

Even with some remnant of a season, pitching Chris Sale in 2020 seems dicey – maybe not a good strategy for the Red Sox until they have assurance that his arm is whole and healthy beyond just giving it more rest and sending good vibes its way. Get it fixed. Otherwise, even with a shortened 2020 season, Sale and the Red Sox risk further injury with the possible loss of the entire 2021 season along with it. From the team’s point of view, that’s $59 million down the tubes – 40 percent of his five-year extension wasted. Why chance it?

Let’s quickly review the latest saga of Sale and his left elbow: how the Sox put him and his sore arm on ice for the last six weeks of his horrendous 2019 season; how he then received a platelet-rich plasma (PRP) injection from orthopedic surgeon Dr. James Andrews; how he was then cleared in late fall by Andrews to resume throwing; and then how he woke up one day in spring training with, again, a sore elbow after throwing 15 pitches in live batting practice the day before. Sale was told to give it a rest of 10-14 days, and he was set to test his arm again when Manfred pulled the plug on spring training.

Sale was diagnosed with a flexor tendon strain following the 15-pitch session, when ordinarily it takes a torn ulnar collateral ligament (UCL) to warrant the invasiveness of Tommy John surgery. As described by Johns Hopkins Medicine, that’s a procedure in which a healthy tendon is taken from elsewhere in the body and used to replace the torn ligament. Surgeons drill holes in the two bones originally connected by the UCL, after which the grafted tendon is threaded through the holes and attached. Recovery and rehab from such surgery can take 12-15 months (or more) for a pitcher before he’s ready to pitch in a game.

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Another type of surgery, one with a recovery period about half that of Tommy John surgery, is a procedure that former Red Sox pitcher Rich Hill, now with the Los Angeles Dodgers, underwent this past November. Hill had what’s known as “primary repair” – or “primary revision.” According to Dr. Jeffrey Dugas, an orthopaedic sports medicine surgeon at the Andrews Sports Medicine and Orthopaedic Center, as reported at stack.com – primary repair involves attaching a piece of super-strong tape coated in collagen directly to the UCL to aid the ligament’s healing. It’s the same type of less-invasive surgery that Seth Maness, a pitcher then with the St. Louis Cardinals, had in October 2016 to repair a torn UCL.

Primary repair could be a long-term solution for Sale and a sounder investment for the Red Sox. Recovery from primary repair surgery is pegged at a more palatable 6-8 months. In Sale’s case, that could have him back pitching full throttle for the Red Sox well before the start of the 2021 season – if he gets the surgery now. Otherwise, it’s wait and see, hold your breath, throw a quarter into a wishing well, and hope for the best for the Red Sox. Is that how the Sox – and Sale – really want to go into whatever there is of a 2020 season? Didn’t think so.

If there is any sort of a season in 2020, and if it’s one without Sale, the Sox would apparently go with a starting rotation of Eduardo Rodriguez, Nathan Eovaldi, Martin Perez, and presumably Ryan Weber and an opener and/or recently acquired Collin McHugh, if McHugh is sufficiently healed from elbow issues of his own by then.

Something else to contemplate, for the fun of it: if the 2020 season does get wiped out, former Red Sox outfielder Mookie Betts could become a free agent without having played a regular season game for his new team, the Dodgers. Conceivably, the Red Sox could then re-sign Betts to his expected whopper of a contract, and bring him back to Boston to possibly finish his career there, never having played a game for any team other than the Red Sox.