On Tommy John surgery

The Monday print column — on what the Twins should do with Francisco Liriano (above) — isn't quite what I expected to write on the topic.

I expected — wanted — to marshall more facts, to be able to confidently assert that pitchers who've had the surgery fare better in relief than as starters.

But it's a slippery topic, albeit an important one.

It's important in part because so many pitchers have had the procedure. The Twins this season alone have used at least five pitchers — Luis Ayala, Sean Henn, Phil Humber, Liriano and Carl Pavano — who've under gone the ligament-replacement surgery popularly known as "Tommy John surgery." And then there's Pat Neshek, rehabbing from the surgery (and expected back next season) and Bobby Korecky (lopped from the 40-man roster just before spring training to make room for Ayala).

Obviously, knowing what to expect from TJ pitchers would be of value.

But deriving sound answers isn't easy. A few points:

1) A reliable list of pitchers who've had the surgery isn't readily available. Wikipedia has a couple of lists — the link is to the longer of the two — and I know of pitchers who've had the surgery and aren't on the list, and I doubt that some listed have had the surgery. (I can't, for example, find a gap in the records of either David Wells or Kenny Rogers that would be attributed to ligament replacement, but Wikipedia claims both had had it.)

2) Not all patients have the surgery under the same conditions. There's a difference between the surgery for Andy Ashby — who had the surgery at age 36 with 98 career wins under his belt and appeared in two major league games after it — and the same procedure for Liriano, who was about 23 when he had the surgery. Ashby had had his career; Liriano's was just getting started.

On a different level, consider the complexities of former Twin Grant Balfour. He made a splash in the Minnesota bullpen in 2004, then had not only TJ surgery on his elbow but surgeries on his rotator cuff and labrum. It took him four years and four organizations to make it back from all that. How much was elbow and how much the shoulder?

3) Defining success. A 2008 study said 83 percent of patients returned to at least the same level of competition, but that sounds better than the reality. Ashby returned to the major leagues after his surgery, but it was pretty meaningless. Joe Mays spent part of a season in the Twins rotation, but wasn't competent. Their surgeries were undoubtedly medical successes, but I would rate them as athletic failures.

And so I wind up reluctantly relying, still, on anecdotal evidence. And the anecdotal evidence conflicts. John Smoltz spent years in the pen before returning to the rotation; Josh Johnson of the Florida Marlins went right back into the rotation and is better than before.

Still I have a few opinions — the opinions of a fairly well-read amateur on the subject, opinions subject to change as evidence emerges:

1) For all the chatter about pitchers coming back from Tommy John with improved velocity, it's fairly rare. Most TJ pitchers experience decreased velocity. When it happens, it's a combination of a newly full-strength elbow and better conditioning through rigorous rehab.

2) If a pitcher has a choice, it's probably best to avoid Tommy John surgery — and that's particularly the case for pitchers with high-velocity fast balls.

3) Experienced pitchers appear to recover better, athletically, than young ones, perhaps because they're better able to cope with diminished stuff.

4) Relief work is the better post-surgery role.

5) There are obvious exceptions to all these opinion. There is no one-size-fits-all template.