How Will John Lackey Pitch After Tommy John Surgery?

Christopher Pasatieri

Looking back through recent history might give us an idea of appropriate Lackey expectations

There are concerns about how John Lackey is going to pitch in 2013 after missing the entire 2012 campaign due to Tommy John surgery. Some of these concerns stem from his awful 2011, in which Lackey dealt with elbow troubles, a stint on the disabled list, and a cortisone shot, events that led to the surgery in the first place. While the negativity surrounding that is likely overstated -- Lackey, in theory, should be healthy in 2013, whereas in 2011 he was not -- the other problem surrounds what can be realistically be expected out of him at his age, post-Tommy John.

The only way to get a real sense of that is to look back and see how other pitchers have done after going under the knife for the same procedure. Generally, pitchers who undergo Tommy John surgery are younger than the 33-year-old Lackey, and the procedure is ever moving forward in terms of efficiency and positive results as it's become more commonplace. Given this, the sample of pitchers in a similar situation to Lackey is not enormous, but there are enough cases since 2005 to get a sense of reasonable expectations.

From 2005 through 2011, 10 pitchers ages 31-to-33 -- including Lackey -- underwent Tommy John surgery. Except for Lackey, all of them have already returned from the procedure and pitched. Of those nine, seven are starting pitchers: the other two are relievers Octavio Dotel (2005) and Rich Hill (2011). It's the seven starters we want to concern ourselves with, as that's the role and the routines that Lackey will be involved with in 2013.

If you're looking for a positive in Lackey's return, the names in this group might just lead you to one: Carl Pavano (2007), Chris Carpenter (2007), Bruce Chen (2008), Jake Westbrook (2008), Tim Hudson (2008), Ben Sheets (2010), and Daisuke Matsuzaka (2011). Dice-K is probably the primary reason why some Red Sox fans find it hard to believe that Lackey could come back and pitch well in 2013, but let's remember that Matsuzaka's issues extend much further back than the elbow problems that led to his surgery, and have a whole lot to do with his ability in general. Lackey, on the other hand, was disappointing, but not Matsuzakian, leading up to 2011, and in that season, he was pitching while hurt. It's not a fair comparison.

We're going to toss Sheets out of this group, even though it cuts down the sample further, because his surgery was supposed to be career-ending. Instead, he returned briefly in 2012, in order to go out on a more positive note, and did so roughly two full years after the initial procedure.

Pavano's surgery came in early 2007, after he had missed all of 2006 due to, in order, a low back strain, shoulder inflammation, elbow surgery to remove bone chips, and a rib cage fracture from a car accident. He then threw 11 innings for the Yankees before undergoing Tommy John surgery in mid-April, and didn't return to the mound until August of 2008. Like with everything else in his Yankee tenure, Pavano failed to do well, throwing 34 frames of 5.77 ERA ball with a sub-two strikeout-to-walk ratio. Pavano took roughly 15 months to get back to the majors, and didn't pitch well right away. That would have to wait until 2009, when Pavano posted a 3.8 K/BB and 5.10 ERA with the Twins and Indians.

That ERA doesn't make it sound like he's pitching well, but Pavano's batting average on balls in play was .329, and he was a pitch-to-contact hurler working in front of two of the league's poorer defenses. His Fielding-Independent Pitching has him at 4.02 for 2009, much more like the average-ish Pavano he was prior to his ill-fated stint with the Yankees (as well as after). You could blame at least some of that BABIP on a failure of Pavano to command his pitches well, especially while with the Indians -- he gave up 1.4 homers per nine with them in 125 innings -- but a significant chunk of the blame also belongs to the defense behind him. This is especially true when you consider he even managed to best the league-average for line drive BABIP.

Shorter Pavano: he came back in fewer months than Lackey, who will be 17 months from the date of his surgery on April 1, and pitched well after a command hiccup in his first full season following the procedure.

Not everyone else requires as much explanation as Pavano, mostly because no one else had as an unfortunate of a situation to discuss. Carpenter had bone spurs removed in early 2007, and then went in for a second surgery -- this one TJ -- in late July. He returned almost exactly one year later, and pitched well, but not very often. His elbow wasn't to blame, as Carpenter's shoulder, and then a neurological injury, were the culprits. He was sharp in limited duty, but underwent an ulnar nerve transposition in November to complete the work on his elbow. Carpenter then led the NL in ERA in 2009, and finished second in the Cy Young race, tossing 192 innings in the process.

Chen pitched poorly in 2006 and 2007 before undergoing Tommy John in 2008. He would miss the entire 2008 campaign, and return to the mound in late June, nearly 17 months after the procedure. This is one of those moments that's difficult to judge, because, even at his best, Chen is just decent. Or, to put it another way, while he pitched poorly after his surgery, he wasn't any worse than he just managed in 2012, and that was better than his recent pre-2009 work. Both his walk and strikeout rates were around career levels, and he suffered no further elbow issues, so we'll call this as much of a win as you can classify something involving Chen.

Unlike Chen, Westbrook's surgery was in-season, coming at the end of May. His recovery took much longer than what's considered the standard at this point, as he missed the rest of 2008 and all of 2009, except for nine innings thrown in Double-A Akron. From this limited sample, we can see Westbrook was hitting his spots, and struck out six against one walk. With a regular off-season routine heading into 2010, much like what Lackey has experienced this winter, Westbrook ended up with a near-average campaign courtesy a 93 ERA and 202 innings, split between the Indians and Cardinals. As with Pavano before him, some of his performance with the Indians can be placed on the defense, while some, like his uncharacteristic 1.1 homers per nine, was likely due to his command not coming around entirely post-surgery.

Then there is Tim Hudson, who had his TJ on July 28, 2008 after throwing 142 innings with a 132 ERA+ for the Braves. Hudson would return to the majors in September of 2009, 13 months and change from the time of surgery, and threw 42 innings with a 3.61 ERA, all with no noticeable loss of command or control. While expecting Lackey to bounce back like this is asking to be disappointed, it's comforting to know that, for every Dice-K in this group, there's a Tim Hudson to restore balance to the universe.

The general picture drawn by these pitchers is one where command takes a little time to come back, but overall, things shake out for the positive. The fact Lackey is returning to the mound with more recovery time behind him than most should be a bonus for him, as should the regular off-season of preparation that seems to have improved the production of the bunch. Expecting the surgery to turn him into an entirely different pitcher is asking for too much, but if you're thinking it will bring him back to where he was before the serious elbow problems of 2011, that seems like a reasonable expectation as early as April. If that's the case, and Lackey can produce another 2010-type campaign, that's one less question that needs answering in Boston's rotation.

Injury data courtesy Baseball Prospectus' injury database

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