Antone’s return from the third TJS provides hope and a road map for weapons

Of the 2,741 pitchers to have had Tommy John Surgery, according to Jon Roegele’s website, only one major league pitcher – Jonny Venters – is the only organization to have endured three Tommy John Surgeries and returned to play.

Drew Rasmussen endured three surgeries, but the third was a combination Internal Brace procedure. Jason Isringhausen (age 38-39) had third elbow surgery, but it was reportedly not TJ.

Venters (age 33-34) pitched 42.1 innings before retiring after his third surgery (5.31 ERA/4.61 FIP).

Antone was faced with giving up or entering uncharted waters.

Tommy John surgery is a miracle. Many functions have been extended. But Tommy John surgery often creates an impossible obstacle.

There are 173 cases of this type and 59.8% have not returned to play. Those who returned were often less skilled.

Why is it so hard to come back?

I asked orthopedic surgeon Jeffrey Dugas – a pioneer of UCL repair with Internal Brace surgery – last year why having a second TJS reduces the chance of returning to work.

“You put another (tendon) graft on top of an already large piece, and that changes the way the joint responds, how it creates tension … and stabilizes the tendon,” said Dugas of tendon regeneration. “You also have some healing problems because you have already pierced the bone and inserted the muscle there.”

The joint can lose mobility and become unstable.

Kremchek has performed nearly four thousand Tommy John surgeries at his center in downtown Cincinnati. Kremchek highlights another reason for failure rates: Father Time.

“We know that the longest lifespan of Tommy John at this level is about six years. That’s just the way it is,” he said. “If you’re a 30-year-old pitcher in the big leagues and you’ve made it, and you’ve been around for six or seven years, it’s retirement age (if you’re facing a second).”

There is one thing that Anton will do? He was too young to have a second Tommy John, let alone a third, at age 30 in 2024. He had more time left than many arms.

How did the surgery change the inner workings of his arm?

Antone’s first surgery on April 5, 2017 was “straightforward,” he said.

He tore his UCL, and tunnels were drilled — two through his ulna and three through his right humerus to create a triangular tunnel configuration — into which a new ligament would be attached. He had no other related issues.

His second surgery was more difficult.

Those injuries included an avulsion fracture, which is when a muscle or tendon pulls part of a bone away from its main structure. These injuries often occur after Tommy John surgery as the bones break where the canals were drilled in the first surgery, weakening the bone. He also suffered a UCL tear.

“So, they tried to go in there and burn you down, drill a new hole, and reattach the UCL,” cried Antone. “Obviously, the second one didn’t work either. There were some problems with it. I think I was starting to break where that bone broke … where the flexor was sitting on top of that broken bone — not a break anymore, but a break where it was. I think there was some kind of friction going on there, which makes sense.”

That renovation lasted four years and four months before it failed spectacularly.

An MRI last spring revealed that the flexor mass had been completely removed from the bone, taking the humerus with it. There was no sharp pain because the pain receptors were torn. The UCL was released again, although not torn this time. It was far away, it was released like a rope that finally slipped.

Should he try to throw again?

Kremchek said: “I sat down and we had a deep heart, tears on both sides.”

But what surprised Antone was how Kremchek remained positive despite the severity of the injury. One reason? Kremchek thought they had identified one recurring problem they could correct with surgery and rehabilitation: weakness in his flexor mass.

“We can fix the ligament, but I think fixing this flexor mass and getting this to heal properly will take the stress off your leg and give you a better chance to come back to play,” Kremchek recalled telling Antone. “But I said, ‘If not, and you can’t come back and play, you can put your head on the pillow when you’re 45 and say, ‘I did everything I could do.'”

Antone’s mind began to be optimistic. At least he wanted peace of mind. He decided to have surgery. He and his wife also wanted to try to start a family again, and what if, by some small miracle, his future children could watch him explode?

In this effort, Kremchek said he “threw everything at him for the third time.”

Kremchek shaved the bones down so that Antone could say “they could have a fresh start,” and avoid any damage. Kremchek drilled new tunnels, and reattached the UCL. He didn’t need a new graft, but added an Internal Brace for extra support. A veteran surgeon added eight anchors to reattach the flexor mass to the bone, something like rebar to reinforce concrete. For good measure, he also added a patch of collagen to the top of the ligament to further promote healing.

“It’s very difficult,” said Anton. “There’s a lot going on.”

The repair was the first big step on the long road back. But Kremchek said much of what got him back to the big leagues was tied to a tough rehab program, but also testing and dealing with root causes.

Kremchek said re-injuries are often tied to pitchers not making changes.

“I think that was the biggest difference,” Kremchek said. “At the end of the day, rehab is going to be very important. And in terms of his mechanics. If he’s going to get back to this level of play, he’s going to have to fix something.”

Antone would reevaluate how he threw, and what he threw.

When he had recovered enough to throw again, Antone returned to Driveline for an evaluation.