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Tuesday, August 21, 2012
Carl Crawford needs Tommy John surgery


Boston Red Sox outfielder Carl Crawford's brief season has ended with the announcement he will undergo ulnar collateral ligament (UCL) reconstruction (Tommy John surgery) Thursday. The surgery will be performed by Dr. James Andrews.

Carl Crawford
Carl Crawford's throwing may be the last hurdle in his recovery from the Tommy John surgery he'll have this week.

The start to Crawford's season was initially delayed by slow recovery from January surgery to debride a cartilage structure (the triangulofibrocartilage complex or TFCC to be exact, which functions similarly to a meniscus) in his left wrist. Crawford anticipated being able to start the season on time, but a setback of discomfort and swelling after he began swinging a bat resulted in his starting the year on the disabled list. Then, just as it appeared he was nearing a rehab assignment, Crawford injured his left elbow and the team announced that he had a sprained UCL.

Crawford underwent a conservative course of treatment, including a PRP (platelet-rich plasma) injection in an attempt to return to action this season. And he did return. Crawford was activated in mid-July and managed to play fairly well, despite not being 100 percent healthy. One of the challenges given his position was the demand placed on his elbow when making throws from the outfield, something which became increasingly less comfortable as time went on.

Those hard throws from the outfield likely will be the biggest hurdle Crawford has to overcome next spring as he works his way back following surgery. Recovery for a position player following Tommy John surgery often ranges from six to nine months, less than the standard yearlong projection for pitchers. Clearly the throwing demands on the elbow are far greater for a pitcher than for any position player. Among all position players, outfielders may throw less frequently than infielders, but their throws often demand a greater distance, pushing them toward the outer boundary of that timetable. Recovering to the point of making those throws on a consistent basis likely will require extra time for Crawford.

Following surgery, light throwing and hitting can often be initiated at approximately four months, which translates to December for Crawford. By spring training, he should be able to hit against live pitching if all is progressing well. And while a general recovery time frame of eight to nine months puts the calendar at April-May, it may take some additional time for Crawford to comfortably throw from the field to home plate.

As an example, outfielder Xavier Nady was playing with the New York Yankees in 2009 when he sustained his second ulnar collateral ligament tear. He underwent surgery in July of that year, signed with the Chicago Cubs the following January and was active when the 2010 season started. However, he did not play in the field every day and was still restricted on some throws early in the season. He did not make a throw from the outfield wall to home plate until mid-June. Granted, it was Nady's second elbow reconstruction, which warranted extra caution, and no two individuals necessarily recover at the same rate. Still, it should not be considered automatic that Crawford will be in full defensive form when the 2013 season launches. On the positive side, his hitting should not be limited. If his bat can be effective, the Red Sox will undoubtedly find a way to utilize him while his throwing range progresses.