Talk of Tommy John surgery has been prevalent throughout the season, with top young stars like Jose Fernandez, Matt Moore and others needing elbow reconstruction surgery.
It hasn't been limited to Major Leaguers, as some of baseball's top prospects have also needed the surgery over the past year. Five pitchers on MLB.com's Top 100 Prospects list have had the surgery and are at various stages of recovery.
There was a time when such a major operation would greatly harm a player's prospects. But the success rate of the surgery, along with the advancements in rehab techniques that have shortened the recovery timetable, has led many to believe that most players who have the procedure will return to complete health.
Lucas Giolito certainly has helped make the case. The Nationals felt comfortable enough with Giolito's talent and work ethic and the success of the surgery to take the high school right-hander No. 16 overall in the 2012 Draft, knowing that his elbow injury at the time would likely require surgery. He had the operation at the end of August 2012 and was pitching competitively by the beginning of July 2013, less than 11 months later.
What Giolito showed in his 36 2/3 innings was enough to give MLB.com the confidence to rank him the No. 44 prospect before the 2014 season began. It used to be that the first full season after surgery was all about working, building up strength and staying on the mound. That clearly was still the No. 1 priority for the Nats.
"First and foremost, it's about maintaining health," said Nationals assistant general manager and vice president for player development Doug Harris. "We frame things to allow for that to happen, limiting volume both within a game and throughout the course of the year. We monitor the ebb and flow of the season, the intensity and things of that nature."
The numbers, especially in the first year after returning, are secondary. In Giolito's case, though, they're pretty difficult to ignore. Spending the season in the South Atlantic League, Giolito has gone 10-2 with a 2.20 ERA over 98 innings. He's allowed just 70 hits, holding opponents to a .197 average, and struck out 110 in, earning an invitation to pitch in the Futures Game along the way. Giolito has pitched seven innings just once and has averaged just under five innings per start. He's thrown so well that he shot up to No. 10 on the Top 100 list when it was re-ranked in July.
"He's performed at such a level [that] under normal circumstances, he could've gone longer in a ballgame," Harris said. "We're pleased with how he's progressed, with what he's learned and applied and that he's gone out and performed at a high level throughout the course of the whole year. He's been consistent from day one. He's learned a ton and done a great job at applying it. He's in a very good place right now."
The Orioles' Dylan Bundy was drafted a year before Giolito, and he made it to the big leagues in a hurry, debuting in September 2012. He had his elbow surgery in June 2013 and made it back to the mound a year later. Though Bundy was shut down recently with a lat injury -- the Orioles probably won't try to get him back on the hill before the Minor League season ends -- the organization is quite pleased with where he is, even if it had to slow down the hard-working right-hander a bit in the process.
"The best part of his entire rehab is he had no setbacks and he progressed ahead of schedule," Orioles farm director Brian Graham said. "We had to put the reins on him a little bit. He's definitely a guy who wanted to do more and do it more often. Dave Walker, our medical coordinator, he did a tremendous job with Dylan."
Bundy, now ranked the No. 15 prospect, will finish rehabbing his lat injury and likely head home with a normal offseason plan in place, eyeing a full return in 2015 after throwing 41 1/3 innings this season.
Many in Pittsburgh thought Jameson Taillon would help out the big league rotation this year. Instead, the 2009 first-rounder, ranked No. 31, had Tommy John surgery in April. He's obviously behind the other two righties, just four months removed from his procedure. Seeing how Giolito and Bundy have progressed undoubtedly gives the Pirates and Taillon hope he'll make a full recovery.
"Jamo is on schedule and is in the early phases of his throwing program," Pirates assistant GM Kyle Stark said. "The expected recovery times are 12-18 months, with 12 months being sometime in April next year. I would imagine we would be shooting for some time in the first half of 2015 as a return to competition."
That might seem like a wide range of time for a return date, but it speaks to the unknown that still exists when it comes to returning from Tommy John. There are variables that all player-development departments are mindful of while shepherding talented pitchers back to full strength.
Things like age, size and number of innings thrown all are considered when coming up with a plan. The Nationals, for instance, treated Giolito different than they did Jordan Zimmermann and Stephen Strasburg. First-round pick Erick Fedde, who had surgery just before the Draft, will also have his own individualized treatment plan. Giolito is a little more complicated, given his physical maturity (6-foot-6, 255 pounds) compared to his age (he turned 20 in July).
"We wanted to build a foundation for him and recognize the past," Harris said. "If he had experienced a greater number of innings pitched prior to T.J., where he is in his maturation as a man, all these variables are important in the decision making. We want to maximize the foundation and stretch the season.
"He is more mature physically than the majority of most high school draftees. He's still developing as a man and we're cognizant of that. There's a certain baseline there to work off of, but we do detail it to the individual, based on age, prior innings, and what time of the year the player has Tommy John allows you to do some things differently."
Giolito should be able to give his former high school teammate Max Fried of the Padres (No. 71) some advice. Even though they are much different pitchers -- Fried is left-handed and has a much slighter build -- he had his surgery just recently, the same time of year Giolito had his done. Fried is expected to miss most of next season.
Teams are so comfortable with the success of the surgery that they aren't shying away from drafting players who need it. Giolito's was done two months after he was taken, but the Nats took Fedde in the first round and the Blue Jays took Jeff Hoffman (No. 93 on the Top 100) at No. 9 overall. Both players had the surgery pre-Draft, but the organizations believed it was worth rolling the dice.
"We just felt the talent was too good to walk away from," Blue Jays director of amateur scouting Brian Parker said at the time of the Draft. "This guy was going go top three, top four picks prior to his injury, and we just felt like even with the Tommy John, this was a good gamble for us."
Having so much more information on the surgery and how to rehab helps build that comfort level. Graham mentioned a database that Walker and the medical staff with the Orioles can consult, using other experiences to help build a plan for Bundy. Walker himself helped rehab Alfredo Simon and Tsuyoshi Wada, both of whom are pitching in the big leagues now. Medical coordinators also share information with each other. The more that's known, the better chance of full recovery.
And that points everyone in the right direction, toward the future. The hope is that the elbow reconstruction will be just a thing of the past for each of these prospects, a small stumbling block along the way to a long and healthy big league career. Caution will still be taken, especially in what's the early going for each of these young pitchers, but bigger and better things are expected.
"We're cognizant of all of our players' volume, T.J. or not," Harris said. "We constantly monitor volume, we'll be mindful of that going forward with Giolito. But I'm sure he'll be looking forward to 2015 as much as we are with him."
"We absolutely anticipate to being back to the pre-surgery Dylan Bundy," Graham said. "Pitchers control their own destiny. You have to take notice of pitches as well as innings. We have to be good decision-makers on our end."