LAKE BUENA VISTA, Fla. -- Pitcher Brandon Beachy’s arm injury appears to be far worse than he and the Braves initially believed, and he could find out Monday that he needs a second Tommy John elbow surgery and another year-long rehabilitation.
The Braves face the almost unimaginable, but quite real, possibility that starting pitchers Kris Medlen and Beachy could both be told Monday when they visit Dr. James Andrews that each needs to have a second ligament-transplant surgery, aka “Tommy John” surgery. Andrews did TJ surgery on Medlen in 2010 and on Beachy in June 2012.
Medlen, the planned opening-day starter who left Sunday's game against the Mets after feeling stabbing pain in his surgically repaired elbow, had an MRI and other tests this week in Orlando and has already come to grips with knowing he'll almost certainly need Tommy John surgery again.
And now Beachy, 27, knows he might also need his third overall surgery and second TJ surgery in a span of about 21 months. That's assuming that Andrews would even recommend having so many surgeries within such a short period of time.
“Lot of frustration,” Beachy said Friday. “Really, really frustrated.”
Medlen and Beachy would join fellow Braves pitcher Jonny Venters in attempting to be among the few pitchers to come back from two Tommy John surgeries and pitch at or near the same level as before. Andrews has placed the success rate at about 20 percent for pitchers to return to pre-surgery form after a second TJ surgery, and the percentage has been higher for relievers than starters.
Upon leaving Monday’s game against the Phillies after only two innings, Beachy told reporters that he wasn't concerned because he'd been told his new ulnar collateral ligament was "fine" and that he was merely having some biceps tightness from inflammation common for pitchers recovering from surgery (he had an arthroscopic procedure in September to remove a bone chip from his elbow).
"I’ve seen the doctors. They’ve done everything. My ligament’s fine," Beachy said Monday.
He found out otherwise this week when had tests done in Orlando -- he and Medlen had the same tests done -- that showed a possible ligament tear. For patients who've had a previous Tommy John surgery, the MRI can be "cloudy" around the repaired area and difficult to read, but both pitchers also had a stress X-ray that showed apparent ligament damage.
"I was pretty confident when I talked to you guys after the game on Monday," Beachy said. "That was based on what I was told. I was being honest. Now it looks like it might be something else. So it’s frustrating. Very frustrating.”
It's been a long and still-winding road of recovery for Beachy, who had a 2.00 ERA and majors-leading .171 opponents’ average in 13 starts before Tommy John surgery in 2012. He was limited to five starts last season before being shut down again and having his elbow 'scoped.
Andrews, a leading practitioner of Tommy John surgery, did all the previous elbow surgeries on Beachy and Medlen -- and both of Venters' TJ surgeries -- and will view the MRIs and examine the pitchers at his clinic near Pensacola, Fla., before making a recommendation.
If more surgery is needed, it will most likely happen soon afterward -- often an athlete will stay in Pensacola to have the surgery within 24 hours of being examined. Under normal circumstances, Medlen and Beachy would already have traveled to Andrews' Florida clinic, but he and other orthopedic surgeons are at a national conference in New Orleans that runs through the weekend.
After Medlen's injury Sunday, Braves general manager Frank Wren called the agent for free agent pitcher Ervin Santana, and those talks gained more of an urgency after Beachy left Monday's game. The Braves worked out a one-year, $14.1 million deal with Santana on Tuesday night and announced the signing Wednesday.
The Braves are also expected to start the season without left-hander Mike Minor in the rotation, since he was shut down in January following urinary-tract surgery, then missed a week early in camp due to shoulder soreness. Minor has thrown several bullpen sessions but hasn't faced hitters yet in batting practice, and a mid-April return now seems most likely.
Offseason free-agent pickup Gavin Floyd's rehab from Tommy John surgery in May has gone well and he could join the Braves' rotation by early May.
Santana, who threw his first batting-practice session Monday, could get into a spring-training game in the next week. The Braves say they won't rush him into the rotation for the first week of the season, since he signed late and needs to build his pitch-count progression in games. Due to early off days in the schedule the Braves can get by with four starters without any having to go on short rest for the first 10 games of the season.
They wouldn't need a fifth starter until the 11th game of the season, April 12 against the Nationals, and Santana could be ready by then if not sooner.
The Braves are expected to open the season with a four-man rotation of likely opening-day starter Julio Teheran, 37-year-old Freddy Garcia, second-year left-hander Alex Wood, and rookie David Hale. It's quite a bit different than what they had envisioned before Minor's January setback and the injuries to Medlen and Beachy.