The elbow issue that has dogged Boston Red Sox ace Chris Sale since last season has led to the worst case scenario. On Thursday the Red Sox announced Sale will undergo Tommy John surgery. He will miss the entire 2020 season and likely the start of the 2021 season as well. No surgery date has been announced.

"Needless to say, this is a tough thing for Chris and a tough thing for all of us here with the Red Sox," chief baseball officer Chaim Bloom told reporters, including the Boston Globe's Alex Speier.

Sale, 31 next week, was limited to 25 starts and 147 1/3 innings by injuries last season. He was hampered by a flexor strain in spring training and only recently resumed throwing. Flexor strains are a common precursor to Tommy John surgery and apparently Sale's elbow started barking again within the last week or so.

Chris Sale
BOS • SP • #41
2019 stats
IP147 1/3
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The MLB season is on indefinite hiatus because of the growing threat that is the novel coronavirus (COVID-19). Opening Day has been pushed back to at least mid-May, and that remains subject to change as the situation develops. MLB is hopeful it will play games at some point in 2020. When they do, Sale will be unavailable.

Here are five things to know about Sale's Tommy John surgery and what it means for the Red Sox.

1. The injury dates back to 2019

As noted by The Ringer's Ben Lindbergh three years ago, Tommy John surgeries peaks in spring training, and intuitively, that makes sense. Pitchers ramp up their throwing in February and March, and inevitably some do too much, too soon. Luis Severino and Joey Wentz are among the pitchers to have their elbows reconstructed in recent weeks.

In Sale's case, this injury dates back to last season. He never looked quite right last year -- Sale was missing quite a bit of velocity early last season -- and he missed the final six weeks of 2019 with elbow inflammation. There was some thought he'd need Tommy John surgery late last year, but that wasn't the case. Instead, he attempted to rehab the injury, and apparently it didn't take.

2. Sale will likely miss the start of 2021 

These days Tommy John surgery comes with a 14-16 month rehab. The days of a 12-month rehab are pretty much over. There are some exceptions -- Johnny Cueto returned in 13 months -- but, generally speaking, it's a 14-16 month rehab. That means Sale may not return until the 2021 All-Star break even with a setback-free rehab.

There's also a complicating factor: COVID-19. Elective surgeries are being increasingly restricted and scheduling Sale's surgery could take time, according to the Boston Globe's Alex Speier. It's seem unlikely the Red Sox and Sale will have to wait too long for the surgery, but it may not happen immediately, as is often the case with Tommy John surgery.

3. The Red Sox are very short on pitching

Chris Sale's 2020 season is officially over. USATSI

The Red Sox let Rick Porcello depart as a free agent and traded David Price last month, so they were short on pitching even before Sale needed Tommy John surgery. Now their rotation depth is pretty much nonexistent. This is current rotation depth chart:

  1. LHP Eduardo Rodriguez
  2. RHP Nathan Eovaldi
  3. LHP Martin Perez
  4. RHP Ryan Weber
  5. LHP Matt Hall
  6. LHP Brian Johnson

That is ... not great. Rodriguez is a stud, but Eovaldi was limited to 67 2/3 innings last season and has been dogged by injuries throughout his career. Perez had a 5.12 ERA last season (6.27 ERA in the second half) and everyone else on that depth chart is a low-upside journeyman type.

Red Sox interim manager Ron Roenicke indicated the team may use an opener for their fifth starter this year, though the shutdown may change their plans. Boston could stumble into more pitching at some point between now and Opening Day. For now, the Red Sox are very thin in the rotation. Rodriguez is the only sure thing.

4. This is Year 1 of Sale's monster contract

Fresh off their World Series championship last spring, the Red Sox signed Sale to a massive five-year extension worth $145 million. That contract covers 2020-24, so this is Year 1. Not a good start! Here's what the Red Sox owe Sale:

  • 2020: $30 million ($10 million deferred)
  • 2021: $30 million ($10 million deferred)
  • 2022: $30 million ($10 million deferred)
  • 2023: $27.5 million ($10 million deferred)
  • 2024: $27.5 million ($10 million deferred)
  • 2025: $20 million club option

Free agency did bounce back this past offseason, though Sale clearly would've been behind Gerrit Cole and Stephen Strasburg as the market's top pitching options, and maybe behind Madison Bumgarner as well. It's safe to say he would not have come close to a $145 million contract as a free agent given his 2019 season and lingering elbow concerns.

5. Boston may be headed for a rebuild

In fact, the rebuild may have already started. The Red Sox traded Price and Mookie Betts to the Dodgers last month, and they could move impending free agents Jackie Bradley Jr. and Brandon Workman at some point in 2020. Rodriguez will become a free agent following the 2021 season as well. Now Sale will be out until the 2021 All-Star break or thereabouts.

The Red Sox do have several long-term building blocks. Rafael Devers is a bona fide star and under team control through 2023. Xander Bogaerts is signed through 2025 and others like Andrew Benintendi and Alex Verdugo have big upside and multiple years of team control. With the Yankees and Rays at the top of their game though, the Red Sox are probably going to have to take a step back in the next year or two.