It may be more challenging for Angels’ Shohei Ohtani to undergo a second Tommy John rehabilitation, but it is not guaranteed.

If Shohei Ohtani undergoes a second Tommy John surgery, his recovery may potentially be more challenging than the initial one, although it is not guaranteed.

“I had a challenging experience with my initial rehabilitation, and I never truly felt completely recovered,” expressed Jameson Taillon, the pitcher for the Chicago Cubs. “Individuals would approach me and inquire, ‘Hey, buddy, what can I anticipate following a Tommy John surgery?’ My response would be: Perpetual discomfort and never feeling fully well again.”

“My second one was just like a new arm.”

Ohtani tore the ulnar collateral ligament in his right elbow while pitching against Cincinnati on Aug. 26. The unprecedented two-way star is continuing to bat as a designated hitter but won’t pitch again this year while considering his medical options.

Now 29, Ohtani had Tommy John surgery on Oct. 1, 2018, performed by Los Angeles Dodgers head team physician Neal ElAttrache. He returned to the Angels as a batter the following May 7 and to the mound on July 26, 2020, in a season delayed by the pandemic. He didn’t retire a batter in his return, got just five outs on Aug. 2 and left with a strained forearm that kept him from pitching until 2021.

Since that time, his record stands at 34 wins and 16 losses, accompanied by an earned run average of 2.84 in a total of 74 starts.

PHOTOS: A 2nd Tommy John surgery could be tougher for Shohei Ohtani to return from. But it’s not a given

Combine that with his offense the last three seasons – a .278 average, 124 homers, 290 RBIs and 56 stolen bases entering Friday mostly as a designated hitter – and expectations before the injury were that the 2021 AL MVP could command a record $500 million-plus contract as a free agent this offseason.

If Ohtani undergoes the surgery, he will not be able to pitch again until at least 2025. The recovery period for most pitchers typically lasts between 12 to 18 months, although position players tend to return sooner. For instance, Philadelphia’s Bryce Harper resumed playing as a designated hitter in May, only 160 days after the surgery.

The UCL links the upper arm bone to the forearm bone at the elbow joint. Physicians typically opt to substitute a damaged ligament with a long tendon called almaris longus, taken from the forearm. If this option is not feasible, the second preference is to use a tendon called gracilus, extracted from the knee.

The recovery process for a second surgery is usually more complex compared to the first one, as scar tissues and bone spurs can affect the healing time. Typically, pitchers are able to start throwing again around week 17 after their initial Tommy John surgery. However, Dr. David Altchek, the medical director of the New York Mets, has stated that after a second Tommy John surgery, the resumption of throwing may be postponed until week 21 or possibly even week 41.

“I have observed a high rate of re-tears,” stated Altchek, who has operated on Taillon twice and has conducted approximately 1,800 Tommy John surgeries since 1993.

“We believe that certain training techniques could be a contributing factor: specifically, the use of weighted balls. I do not oppose the use of weighted balls as they do indeed enhance velocity, but they also place excessive strain on the ligament. If I have the authority to determine my patients’ activities, I would prefer them to completely avoid throwing weighted balls with any level of force for approximately one and a half to two years following the surgery.”

Perry Minasian, the general manager of the Angels, has not provided specific information about the tear. He mentioned that Ohtani and his agents are seeking advice from medical professionals.

Dr. Matthew Best, an orthopedic surgeon and director of research at Johns Hopkins’ Sports Medicine Division, stated that there is still a significant amount of information that remains unknown. This information is crucial in determining the necessary recovery process and whether surgery will be required.

A spreadsheet of Tommy John surgery patients compiled by baseball analyst Jon Roegele lists 2,345 procedures, starting with Tommy John himself on Sept. 25, 1974, through Dodgers pitcher Tony Gonsolin on Friday. Roegele records 148 players who have had the procedure twice, including three times each for Jason Isringhausen, Jonny Venters, Ben Leeper and Corey Black.

“I cannot reword”

“The precise positioning of performing the surgical procedure involving tunnel formation and graft passage becomes increasingly complex due to potential alterations in anatomy resulting from previous surgeries and the manner in which healing has occurred.”

“After considering everything mentioned,” he further stated, “the success rate of revision Tommy John surgery is higher than what has been historically reported. Previously, it was believed that undergoing Tommy John surgery for a second time had a success rate of 50%. However, the success rate has now improved to around 60 or even 70 percent.”

Most prominent among those who have come back from a second TJ are Nathan Eovaldi and Taillon. Hyun Jin Ryu returned last month, Walker Buehler is nearing a comeback with the Dodgers, and Jacob deGrom had his second TJ operation in June.

Altchek explained that the expectation is for the healing process of any new tissue to be slower due to the previous disturbance of the environment.