Walker Buehler looks ahead to second Tommy John rehab with hope, but also uncertainty

Walker Buehler awoke after surgery last month, received the news he had been quietly bracing to hear, then put himself back in a familiar state of mind.

For the second time in his career, the Dodgers pitcher had to undergo Tommy John surgery, when damage to his ulnar collateral ligament was discovered and repaired during a season-ending elbow operation on Aug. 23.

He didn’t receive the official diagnosis until he had woken up from the anesthetics, since pre-surgery MRI exams hadn’t been able to clearly determine the full extent of an elbow injury that’d kept him off a mound since June.

Yet he had been preparing himself for the worst-case scenario anyway, knowing that in addition to a flexor tendon repair, a full reconstruction of his UCL was possible.

“I just felt that was important for me going under anesthesia and knowing what I was going to come out with,” Buehler said. “I didn’t really want to be surprised.”

Discussing the injury publicly for the first time Sunday, Buehler was already looking to the long road ahead.

He’s well-acquainted with the process, having undergone his first Tommy John surgery in 2015, shortly after the Dodgers drafted him in the first round out of Vanderbilt.

He wasn’t ready to rule out a potential return during the 2023 season, though he noted the chances are slim and that he almost certainly won’t be back in a normal starter’s capacity until 2024.

“You get out of surgery, you get the cast off, and some positives start happening,” Buehler said, sitting near his locker in the Dodger Stadium clubhouse. “I just have to put together 12 to 14 to 16 months of positives and hope it works out on the backside.”

Buehler knows it won’t be easy.

Even the most routine Tommy John rehabs can be complicated. Going through it for a second time introduces a new set of variables, something Buehler was still grappling with Sunday.

“I’ve done this rehab, obviously, pretty successfully once before so I think that gives you some confidence,” he said. “But at the same time, it is the second one, so the numbers aren’t quite as clear-cut or in your favor like the first one.”

According to data compiled by MLBReports.com, Buehler is the 70th pitcher to undergo a second Tommy John surgery as a major leaguer.

While the majority of the previous 69 returned to the big leagues, many were never the same, often having brief and ultimately ineffective returns.

Granted, most of them also weren’t as talented as Buehler, a two-time All-Star who has a 3.02 career ERA despite 12 inconsistent starts this year that might have been impacted by his balky elbow.

Still, the pitcher acknowledged the inevitable uncertainties that accompany his current predicament.

“I have a lot of pride in the career I’ve had so far, and hopefully it’s not the end of it,” he said, his mild tone belying the seriousness of his words. “I certainly don’t think it is. But it changes, kind of, the long term.”

There are several pitchers who have had success after two Tommy John surgeries.

Left-hander Chris Capuano was an All-Star early in his career before having a second Tommy John surgery in 2008. He managed to come back to pitch seven more productive big league seasons.

Right-hander Jameson Taillon has reestablished himself in the New York Yankees rotation over the last two seasons after undergoing his second Tommy John surgery in 2019.

Boston Red Sox right-hander Nathan Eovaldi is perhaps the most optimistic example. After having his second Tommy John surgery as a 26-year-old in 2016, he came back to help the Red Sox win a World Series over the Dodgers in 2018 before earning his first career All-Star selection last year.

Buehler referenced Eovaldi by name on Sunday, saying Eovaldi had reached out to him recently upon hearing about Buehler’s second Tommy John surgery.

“He’s first on my mind [of guys] that have gone through two of them and has had success afterwards,” Buehler said. “Seeing that from across the field in 2018, and since, I think his arm is fine. That’s nice and obviously really cool for him to reach out.”

Two of Buehler’s current teammates have undergone multiple Tommy John surgeries.

Daniel Hudson had the procedure twice in the span of two seasons in 2012 and 2013 while he was with the Arizona Diamondbacks.

“I just felt like it was one big ordeal instead of two separate,” Hudson said. “Obviously, it’s not like a death sentence or anything like that. It’s just the amount of time it takes, how tedious the rehab is, how long the throwing program is … the biggest thing is just mentally staying there.”

Caleb Ferguson’s experience is more similar to Buehler’s.

Like Buehler, Ferguson’s first operation came before he ever threw a professional pitch, undergoing the procedure as a senior in high school.

Also like Buehler, Ferguson’s second Tommy John surgery didn’t take place until years later, when his promising 2020 season in the Dodgers bullpen was cut short by another UCL tear he returned from this season.

For Ferguson, having the experience of one successful rehab made the second one easier to navigate.

“You just know what to expect more,” Ferguson said. “I knew my body more, so I knew exactly what was going to work and what wasn’t going to work in terms of trying to recover, or get inflammation out of a spot. It’s not all trial and error anymore.”

The Dodgers are hopeful Buehler can make a similar recovery.

At the time of Buehler’s surgery, president of baseball operations Andrew Friedman said the team considered data on two-time Tommy John pitchers to be “actually really good” — especially when the surgery was performed by Dr. Neal ElAttrache, who also performed Buehler’s first Tommy John surgery and has earned a reputation as one of the sport’s premier orthopedic surgeons.

“We know that Walker is going to do everything in his power to get back and be really smart about it,” Friedman said. “We watched him attack the process in 2015. So we feel good about, whenever he's able, that he'll step right back in and contribute.”

Buehler echoed similar sentiments Sunday, doing his best to find silver linings ahead of another extended rehab process.

“When you have the best surgeon in the world saying he feels really good about it, along with being in with an organization like this that takes care of their players, it’s gonna help me get the best rehab I can,” Buehler said. “[They’ll] make sure that mentally I’m still good and still enjoy my life a little bit. That’s what you want. If you’re gonna have to get a second Tommy John, I’m in about as good a position as can be.”

This story originally appeared in Los Angeles Times.