Tommy John surgery recommended for Phillies top pitching prospect

The Phillies announced Wednesday morning that their medical staff has recommended an ulnar collateral ligament reconstruction (i.e. Tommy John surgery) and ulnar nerve transposition procedure for top pitching prospect Andrew Painter. He’ll receive a second opinion from Dr. Neal ElAttrache next week before proceeding with the operation. Assuming he indeed undergoes the surgery, he’ll miss the remainder of the 2023 season and quite possibly the majority of the 2024 campaign.

“Right-handed pitcher Andrew Painter has been undergoing conservative management for a right elbow partial ulnar collateral ligament (UCL) injury since March 2, 2023,” the Phillies stated in a press release. “While he was able to return to throwing bullpens and follow-up imaging has shown interval healing in his elbow, over the last few weeks, he continues to be symptomatic upon examination. Considering the timing of the season and that Painter is still experiencing symptoms, the Phillies medical staff has recommended he undergo a right elbow UCL reconstruction with ulnar nerve transposition surgery. Painter has a surgical consult with Dr. Neal ElAttrache on Monday, July 24, 2023 in Los Angeles, Calif.”

Phillies president of baseball operations Dave Dombrowski indicated Tuesday night that Painter was no longer being viewed as a rotation option for the current season, though at the time Dombrowski did not divulge this recommendation. Fans will surely be frustrated given that Painter’s UCL injury was first diagnosed back in March, but surgery is always a last resort. As common as Tommy John procedures have become, a pitcher’s full recovery is hardly guaranteed. We frequently see pitchers take longer than 12 to 14 months to recover due to setbacks and/or return with diminished stuff. Noah Syndergaard stands out as one prominent recent example of both scenarios.

The Phillies consulted with outside medical experts back in March, and all involved parties agreed on a conservative approach with Painter, knowing full well this could be the eventual outcome. While certainly not unforeseeable, the setback is still a blow to the team's future.

Painter entered the season lauded as one of the sport’s top prospects at any position. The 2021 first-rounder breezed through three minor league levels last year as a 19-year-old, posting a combined 1.56 ERA through Low-A, High-A and Double-A. Along the way, he fanned a massive 38.7% of his opponents against a tidy 6.2% walk rate.

That huge showing not only catapulted Painter up national prospect rankings — it thrust him into competition to claim the No. 5 spot in the Philadelphia rotation this spring and make his MLB debut before even celebrating his 20th birthday. The spring elbow injury derailed that trajectory though, and Painter’s earliest path to the majors is now likely in 2025. He’ll require at least 12 to 14 months to recover from surgery, and the Phillies will surely be cautious with his rehab and any minor league innings next season as he builds back up late in the summer.

Given Painter’s injury and the struggles of left-hander Bailey Falter, rotation help could be a major focus for Dombrowski and his staff in advance of the Aug. 1 trade deadline. Falter opened the season in the rotation but has since been optioned to Triple-A. Fellow lefty Cristopher Sanchez has performed well in six starts since being given an opportunity, but the Phils have received less quality than hoped from top starters Zack Wheeler, Aaron Nola and Taijuan Walker — all of whom have ERAs between 4.00 and 4.27. Ranger Suarez has fared a bit better (3.84 ERA) but also been limited to 12 starts due to injury.

The Phils have a solid quintet of starters right now, but the depth beyond that group is shakier. Adding a proven starter to stabilize things surely has some appeal — particularly if said starter is controlled beyond the current season. Nola is a free agent at season’s end, and Painter isn’t likely to pitch until late next summer, so bringing in some help not just for this year but for next season as well could prove prudent.