September 15, 2006
Under The Knife
So I'm sitting on the set of "SportsCenter" … and isn't that a great start to a story?... Anyway, I'm sitting there, just having taped a quick 30-second bit discussing Francisco Liriano when the news came across the wire that there was "no new structural damage." My spot was instantly dated and, without new information, I wasn't prepared to add to the discussion just then.
I'm ready now.
Francisco Liriano is without question one of the best young pitchers in the game. The Twins have a spotty record of developing pitchers, with most coming in trade, making Liriano both the centerpiece and the prototype. Paired with Johan Santana, the young Venezuelans were thought to be a pair of aces not seen in Minnesota since...ever. Liriano doesn't have the track record to allow us to compare these Twins with the Randy Johnson/Curt Schilling Arizona staff, but saying that they were better than the Dontrelle Willis/Josh Beckett pair is easy. Santana alone is one of the most dominant starters over a three-year period in any era, drawing reasonable comparisons to the peaks of Pedro Martinez and Sandy Koufax.
Liriano came up slowly, and when he finally made the team, he was pushed to middle relief. This is a pattern that the Twins had used with Santana with some success, a pattern often attributed to Earl Weaver but in fact a baseball standard since the early 1900s. This year, Liriano's pitch counts were not outrageously high--his highest count was 111 and he ranks 141st on the Pitcher Abuse Points charts. His Stress score was 1! His mechanics, while not perfect, weren't so out of whack that he caused pitching coaches pain just to watch. His mechanics are, in fact, very reminiscent of Santana's, making me wonder if Liriano might have similar bone chip problems during his career.
So what went wrong? If the Twins did everything "right" and there's no discernible objective or subjective evidence for why this occurred, do we as analysts and baseball fans throw up our hands and call it luck? Do these things "just happen"? The answer is simple--we don't know. All the research that has been done has only touched the very tip of the iceberg. PAP, the best available proxy for pitching fatigue and increased injury risk, is not perfect. Mechanical analysis, as far as I can tell, was never done on Liriano at any point, though there's no suggestion that this might have prevented this or any other injury. We don't know about Liriano's conditioning regimen, genetic makeup, pain tolerance, pitch cost or any other of a multitude of factors that influence baseball players.
What we do know is that Liriano had a small tear in his UCL. Even the Twins don't appear to be sure when the initial injury occurred, but in the early-August MRI, there was scar tissue noted from a previous, partial thickness tear of the ligament. If we picture the ligament as a rope, then Liriano's rope had a chunk out of it. The body repairs itself with scar, but scar is not as strong. It's as if the body uses duct tape to keep the rope useful.
When the Twins released Thursday's statement that there was "no new structural damage," the implication is there on the surface that the scar had not held, that there was, simply put, a partial thickness tear of the ligament in the same spot. The body will now begin its organic process of "taping up" the ligament all over again. Just as before, there's no guarantee that it will hold. Reports suggest that the original tear was roughly 20% of the full thickness of the ligament. Add in the imperfection of MRIs and there's a margin of error there. While the initial reports indicate that Liriano has avoided surgery, I'm not convinced that he's in the clear just yet.
Baseball teams, especially conservative ones like the Twins, like certainty. Liriano's elbow will put the Twins in much the same position for 2007 that the Cubs were in going into 2006 with Kerry Wood. They expected him to be healthy and planned around that. When he wasn't, the team began a downslide, helped along by an assortment of other injuries. If Liriano can't be counted on to be their number-two starter, the Twins will have to rely on depth or use the money freed up by Brad Radke's retirement to buy some certainty. The most dangerous scenario for the Twins is letting Liriano rehab the injury over the winter, planning around his return, then watching him break down early in the season.
Doctors I spoke with today didn't feel comfortable suggesting that Liriano should undergo "pre-emptive Tommy John," as one orthopedist stated it. Most took a conservative tack, hoping that Liriano would request a second or even a third opinion. The most intriguing idea came from a team doctor who suggested that the timing might help Liriano. "Why not put a scope in and look around? If it's torn enough to Tommy him, you do it then and you're done with it. If it's not, you know it. Period. He'll have plenty of time to recover and maybe you'll learn something about what's going on in there." I'm no doctor, so I won't suggest that one of these courses is more correct than any other. The Twins certainly have more information and more motive for making sure that Liriano gets the best care.
Where I worry is that Liriano is not the last young stud to break into the game. I don't know if we'll eventually put Liriano's name next to Santana, Koufax and Tom Seaver or on the pile with Mark Fidrych, Bill Pulsipher and Bud Smith. The key to making the game better is constantly working to figure out how to avoid repeating mistakes. I don't have all the answers and sadly, neither does anyone else. If we can't prevent Francisco Liriano from breaking down, maybe he can be a data point towards saving the next ace that comes along.