5 thoughts on Chris Sale dodging surgery - Hold the victory lap on second-guessing the extension

Red Sox starter Chris Sale traveled to Pensacola, Fla. on Monday -- accompanied by head athletic trainer Brad Pearson -- to get a second opinion on his ailing left elbow from noted orthopedist Dr. James Andrews.

Andrews found that Sale was indeed dealing with inflammation and treated Sale with a platelet-rich plasma (PRP) injection. He also recommended that Sale refrain from throwing and will be re-evaluated in six weeks, or, about the end of the regular season.

Here are some thoughts:

1. The odds were are against good news, but not unprecedented

While pitchers traveling to see Dr. Andrews don't always come away with a dire diagnosis -- former Red Sox starter Josh Beckett visited Andrews in 2008 and was told that his elbow was structurally sound and that no surgery would be necessary -- such cases, frankly, are the exception rather than the rule.

Traditionally, pitchers making the trek to the panhandle are merely getting confirmation of a previous diagnosis, and often, that translates into Tommy John surgery.

Fortunately for the Red Sox, surgery has been ruled out -- at least for now. It also almost certainly means that he will not pitch again in 2019, dealing a big blow to the team's already-longshot wild card hopes. The Sox were already scrambling to fill out their rotation, and now can't lean on Sale for the stretch run.

In the big picture, however, that's a small price to play.

Had Sale been facing with Tommy John surgery, it would have meant he wouldn't pitch again until 2021. Recovery time for pitchers is typically 12-15 months and even if Sale had been on the short side of that timetable, that would take him into late August of next season.

Even if a less serious option would be less invasive procedure — removal of bone chips, say, not unlike what Nathan Eovaldi underwent earlier this year -- Sale would still presumably be ready for spring training.

Frankly, Monday's outcome was something of a surprise. The fact that Sale "need(ed) a couple of days'' before addressing the media, according to Dave Dombrowski, surely didn't bode well and suggested  Sale already feared on Saturday that he was likely facing a worst-case scenario.

And perhaps he was. But for now, the Red Sox have dodged a big one.

2. No easy replacements on the horizon.

It should be noted that the Sox are likely not out of the woods yet. It may well be that Sale is dealing with a small sprain -- or tear -- of the ulnar collateral ligament and that could still worsen, to the point where a procedure is necessary. The Yankees, for example, have been dealing with that exact condition with Masahiro Tanaka almost from the time they signed him out of Japan. To date, Tanaka's elbow has held up, but the Yankees must deal with the knowledge that the next pitch he throws could be his last for a while.

As disappointing as Sale's season has been, he remains a top-of-the-rotation starter, still only 30 years old, and it's virtually impossible to see how the Red Sox could fill his absence if the PRP injection and rest don't improve the elbow.

In all of baseball, there are only a half-dozen or so starters of that caliber, the kind capable of Top 5 Cy Young Award finishes, as Sale was in the six previous seasons before this one.

The Red Sox will go into 2020 with a rotation of David Price, Nathan Eovaldi and Eduardo Rodriguez -- not a bad foundation, but hardly a complete group. They would need to find two additional starters if Sale is indeed gone for any period of time.

It's possible that, should Sale be sidelined next season, too, the chances increase of the Red Sox extending a qualifying offer to Rick Porcello, since he has been a remarkably durable innings-eater over his career -- both here and in Detroit. In his 11 seasons, Porcello has made 30 or more starts eight times and will likely top that number again; in the other two seasons, he made 27 and 28 starts.

Then again, do the Red Sox really want to pay somewhere in the neighborhood of $18 million for a pitcher who currently has a 5.49 ERA? Porcello is a staff leader, as competitive as they come and a great teammate, but at some point, performance trumps all other variables. And even a good season from Porcello -- say, 15 or so wins and an ERA of around 4.00 -- doesn't fit the profile of an ace.

The free-agent pool is a limited one, with Gerrit Cole the lone No. 1 on the market. And even if Cole doesn't remain with the Houston Astros, he'll surely get a multi-year deal with an AAV (average annual value) in excess of $25 million. The Red Sox aren't about to have three of those (Sale, Price and Cole) on the same staff.

3. Payroll limitations will be a factor.

The Red Sox have exceeded one form or another of the luxury tax threshold for two seasons in a row. Currently, they have nearly $140 million committed to just seven players. There will be significant escalators for a number of arbitration-eligible players. Mookie Betts alone will likely make more than $25 million; Jackie Bradley Jr. and Rodriguez combined will result in another $20 million or so.

That's $185 million for 10 players - without taking into account smaller arbitration jumps for relievers such as Matt Barnes, Brandon Workman and Heath Hembree.

In short, it's a virtual certainty that the Sox will top $200 million payroll for a third straight season -- and that's without a single acquisition -- via a trade or free-agent signing -- from outside the organization.

4. Sale's status is a reminder of the fragile nature of veteran pitchers.

Remember when the Sox swore off contracts for pitchers over 30, resulting in them low-balling Jon Lester? Principal owner John Henry noted at the time that veteran pitchers were often bad investments because of their propensity for breaking down.

In recent years, in an effort to field championship-level teams, they've gone against thinking, giving David Price the biggest contract ever -- in terms of total dollars, if not AAV -- and then signed Sale to a five-year, $145 million extension this past spring.

To the degree that the Sox have three division titles, three postseason appearances, and yes, a World Series title, the strategy has paid off. But going forward, the returns are likely to be diminishing.

Price has been a mixed bag (46-24, 3.85) -- good, but not great. And Sale, ominously, has not yet had his extension kick in, since it begins with the 2020 season.

But still...

5. Hold the victory lap on second-guessing the Sale extension.

Did the Red Sox take a big risk by signing Sale to an extension this spring? Surely. Sale was coming off a 2019 season in which he was limited by a shoulder issue over the final two months.

But the team did its medical due diligence and found that the shoulder -- through extensive baseline testing and MRIs -- was completely recovered.

The fact that Sale has suffered an elbow injury of some sort doesn't mean the Sox was wrong to sign Sale when they did.

Big, long-term contracts are, by nature, fraught with risk. That's the price that comes with paying athletes to do demanding things to/with their bodies. Surely, Henry, who made his initial fortune dealing in hedge funds, understands that gambit more than most.

Tommy John surgeries, while frustrating, do not signal the end of a career. It's entirely possible that, should he eventually need to undergo one, Sale can still be an elite pitcher.

And while the 20-20 hindsight indicates the Sox would have been better off waiting, there was risk there, too. In the evaluation of many, the Sox got Sale at least a slightly discounted rate. Had they waited, they ran the risk -- there's that word again -- that he had another elite season and attracted even bigger offers from the likes of the Yankees and others.

So, second-guess all you want. But from here, it was a move the Red Sox should have made.