Wednesday afternoon the Angels announced a recent MRI showed new damage to Ohtani's elbow ligament following his return to the mound Sunday, and elbow reconstruction has been recommended. No surgery date has been set and it's possible Ohtani will seek a second opinion before committing to Tommy John surgery. Here is the team's announcement:
RHP/DH Shohei Ohtani underwent an MRI on his right elbow earlier today. The imaging revealed new damage to his ulnar collateral ligament (UCL). Based on these findings, UCL reconstruction surgery is the recommended plan of care. Additional information will be provided when appropriate.
Once Tommy John surgery is recommended, it is typically a foregone conclusion, even with a second opinion. Players seek second opinions because the collective bargaining agreement allows them to, and because they want to be absolutely certain a major, potentially career-altering procedure like elbow ligament reconstruction is absolutely necessary.
Tommy John surgery would almost certainly sideline Ohtani as a pitcher until 2020. It's unclear whether he'd be able to hit in 2019. It is worth nothing that Ohtani remains in the team's lineup for Wednesday, indicating he has been cleared to continue hitting in the immediate future.
When the Angels signed Ohtani over the winter they did so with the knowledge he had a Grade 1 ulnar collateral ligament sprain in his elbow and was receiving treatment. A sprain is by definition a tear, with Grade 1 being least severe. The sprain progressed to Grade 2 at midseason and Ohtani spent roughly a month while receiving treatment. He was cleared to return as a hitter in early July and cleared to pitch a few weeks ago.
Sunday night Ohtani took the mound for the first time since June 6, and, while being held to a strict pitch limit, he allowed two runs in 2 1/3 innings against the Astros. He struck out two and ran his fastball as high as 99.3 mph. His velocity did drop significantly later in the start, however, which wasn't terribly surprising at the time given the long layoff. Here is Ohtani's pitch-by-pitch velocity from Sunday:
Why did the Angels pitch Ohtani on Sunday? Well, why not? Tests at the time confirmed he did not need Tommy John surgery, he completed his rehab work, and doctors cleared him to pitch. His elbow ligament had passed all the necessary tests. Had he pitched and stayed healthy through September, he'd have peace of mind heading into the offseason in 2019.
Had he not stayed healthy -- and this is exactly what happened -- the Angels and Ohtani would've found out right away rather than next spring. Again, his elbow ligament was as healthy as it was going to get. Waiting wasn't going to make the ligament any stronger. As crass as it sounds, it's better to find out he needs Tommy John surgery now rather than next spring training.
Ohtani, 24, finishes his MLB rookie season with a 3.31 ERA (128 ERA+) and 63 strikeouts in 10 starts and 53 1/3 innings. He gave everyone a glimpse of his potential in his second start with the Angels, when he struck out 12 and took a perfect game into the seventh inning.
At the plate Ohtani is currently hitting .276/.355/.547 (144 OPS+) with 16 doubles and 16 home runs in 274 plate appearances. For comparison's sake, Ohtani's offensive production is on par with Nelson Cruz (143 OPS+) while his pitching production is on par with Charlie Morton (127 ERA+). He was outstanding, albeit in limited playing time. Ohtani and Babe Ruth are the only players in history with 50 innings pitched and 15-plus home runs in a single season.
The typical Tommy John surgery rehab timetable for a pitcher is 14-16 months. For a position player, however, it is closer to 6-8 months. It's unclear whether Ohtani would be able to (or allowed to) serve as the DH at some point next season while still rehabbing as a pitcher. That's something the Angels, the doctors, and Ohtani will have to figure out.