BRADENTON, Fla. By now, the time line for recovery from Tommy John surgery is familiar even to the casual baseball fan. It takes at least a year, usually more. It takes tedious, monotonous work on the part of the player.

Alternatives exist, but until now their use among established major leaguers has been limited if tried at all. This season could provide a referendum on two of them. One surgical procedure could cut the recovery time in half. Another treatment could help a player avoid surgery altogether.

I think it can definitely help the game, right-hander Seth Maness, who had a modified elbow ligament surgery in August, said by phone from spring training in Arizona. But the circumstances have to be right.

Maness had a surgery on his right elbow known as a primary repair or primary brace. The procedure reattaches the elbows ulnar collateral ligament to the bone with collagen-coated Arthrex tape. Los Angeles Angels starter Garrett Richards received a stem cell injection into his right elbow to heal his damaged UCL. So far, its working.

The last thing you want to do is have surgery, and if you do what your body does naturally, thats going to be stronger than any replacement surgery, Richards said, also by phone from spring training in Arizona. I just hope that this further gives guys a little bit of knowledge that you have options.

Neither procedure will replace Tommy John. Stem cells dont work in every case, and if the UCL is torn across the middle of the ligament, it needs to be replaced. The sample size for both is also small. But both provide options involving less recovery time for pitchers whose injuries fit a certain profile.

Maness, 28, spent four seasons pitching out of the St. Louis Cardinals bullpen and signed a minor league contract with the Kansas City Royals in February. Maness ligament had pulled away from the bone rather than tearing across the middle. Instead of needing a full Tommy John surgery, which requires grafting a tendon from the wrist or hamstring into the elbow to replace the UCL and at least a year of recovery, Maness was a candidate for a primary repair.

Really this primary brace technology had been used more widely in Europe, particularly for ligament injuries of the knee and the ankle, said Dr. George Paletta, St. Louis Cardinals head orthopedic surgeon who performed Maness surgery. So the concept or the idea was, OK, its working well there, is there a way to adapt it to the elbow?

Paletta had done roughly 60 primary repairs on amateur pitchers prior to operating on Maness and saw an average recovery time of 6 months. That background helped him establish three criteria he needed a young pitcher, an otherwise healthy ligament and, most importantly,the ligament needed to pull off the bone on one end rather than tear in the middle.

Weve had a lot of experience with ligaments healing directly to bone and we have a good understanding of that timetable, so we knew that by about 12 weeks after surgery, this repair should be pretty well healed and pretty solid at that point, Paletta said.

Cardinals reliever Mitch Harris also had the primary repair, as did a third pitcher with major league experience, according to the St. Louis Post-Dispatch, with whom Maness first discussed the procedure in January. Cardinals non-roster outfielder/pitcher Jordan Schafer had the procedure this month.

The UCL in Richards right elbow had a tear running along the ligament, not across it. He sought second opinions from noted orthopedic surgeons Dr. James Andrews and Dr. Neal ElAttrache.

Dr. Andrews pretty much told me, Hey Garrett, if you were my son, I would try the stem cell first, Richards said.

Doctors removed stem cells from his pelvis and injected them into his elbow, in hopes the cells would heal the UCL. Stem cells, extracted from bone marrow, are able to develop into multiple different tissues and can promote healing.

It just feels tight. Youre putting fluid into a place that pretty much doesnt have any room for any more fluid, Richards said of the injection. If you can imagine youre just overfilling a certain area with this nice special sauce.

Teams sometimes use platelet-rich plasma injections, where blood is spun in a centrifuge to isolate growth factors Takashi Saitos PRP injection in 2008 was believed to be the first for a major league pitcher, and Masahiro Tanaka also has pitched successfully with a partially torn UCL after PRP treatment but stem cells are less common. Bartolo Colon, soldiering into his 20th major league season at 43 years old, had a stem cell treatment in 2010. Boston Red Sox left-hander Drew Pomeranz had a stem cell injection in his elbow this winter to address lingering soreness.But Pomeranz went on the disabled list Thursday with left forearm flexor strain.

It doesnt always work. Richards teammate, lefty Andrew Heaney, needed Tommy John last summer after stem cells didnt do the trick.

Richards six-week exam showed significant growth. His three-month check showed even more. He reported no issues this spring, his high-90s mph fastball is back and he is on track to open the season in the rotation.

Everything feels great, Richards said. Basically I took the year off, let my arm heal and now Im back doing what I always do. I just feel refreshed.

Bill Brink: bbrink@post-gazette.com and Twitter @BrinkPG.

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How new-age medicine is helping Major League Baseball pitchers avoid injury - Pittsburgh Post-Gazette

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