McAdam: Chris Sale to undergo Tommy John surgery (Updated with quotes from Chaim Bloom)

If, indeed, there is a 2020 baseball season, it will take place without Chris Sale.

The Red Sox announced Thursday afternoon that Sale will undergo ulnar collateral ligament reconstruction surgery -- commonly known as Tommy John surgery -- and will miss the remainder of the 2020 season. Recovery time for pitchers undergoing Tommy John surgery is typically 12-18 months.

"Needless to say, this is a tough thing for Chris and a tough thing for all of us here at the Red Sox,'' chief baseball officer Chaim Bloom said in a conference call with reporters. "While we are bummed for him, we know that he's going to attack this rehab as he has everything else in his career and we have confidence he's going to do well coming out of it.''

Sale's 2019 season was cut short in August when he experienced elbow pain. He did not pitch after Aug. 13, and visited with famed orthopedist Dr. James Andrews for a second opinion. Andrews was hopeful that a platelet-rich plasma (PRP) injection would prove sufficient to his recovery.

After a period of rest and rehab, Sale began an off-season throwing program and felt strong throughout the start of spring training during bullpen sessions. But the day after a 15-pitch live batting practice session on March 1, Sale experienced some discomfort the following day, prompting additional tests and an MRI, which revealed a strained flexor tendon.



At the time, Sale was told by two doctors -- Andrews and Dr. Neal ElAttrache -- the condition of the ligament was unchanged. He was told to refrain from throwing for 10 days, and early this week, began throwing again to test the elbow.

Last Friday and again on Sunday, Sale threw lightly in the cage in Fort Myers, before attempting to long toss with more vigor Tuesday. It was then that Sale experienced enough pain that he was forced to shut down the activity. Soon after, he huddled with team officials and the determination was made to go ahead with the surgery.

"We knew, when he had the setback at the beginning of the month, that this was a possibility,'' said Bloom. "It's unfortunate. It's not what anybody wants, but we're going to give Chris all the support he needs to get through this and we know he's going to do everything he can to make sure he comes back to the incredibly high level of performance that we've seen from him throughout his career.''

As recently as two weeks ago, the Red Sox said both Dr. Andrews and Dr. ElAttrache said the UCL was unchanged from the original MRI taken last August.

"An MRI can only tell you so much,'' offered Bloom. "Given the history of the symptoms he's experienced, even though there was consensus among the doctors that this wasn't something that warranted surgery, given that he had had this history, it was also agreed upon that if we gave the flexor a chance to calm down and that after ramping back up again, if he experienced pain, surgery would be the next option.''

Bloom said the organization was still finalizing plans for the surgery to take place, which he expects to take place "fairly soon.''

Bloom added that recovery time "obviously varies. I think generally, 12 months would be pretty aggressive. It usually takes longer than that, to make sure you're doing the buildup properly. I think often we see that 14-15 (months) is kind of that mid-range. But everybody is different....Some guys go through the rehab with no bumps in the road, but most guys probably have a bump in the road at some point that slows them down a bit.''

When Sale was first sidelined last August, there was thought that Sale should elect to have the surgery then. Under that timetable, he would have been ready for the start of 2021. But Bloom, who was hired in late October, said that wasn't a consideration.

"Based on what I know of what the determination was last summer,'' said Bloom, "it seemed very reasonable (to take a more cautious approach). This is not something you just want to rush into. This surgery is a big deal. It's not something you want to do unless you really feel that you're at the point where that's what you need to do in order to return to the field.

"Everything that went on last summer -- the symptoms, the imaging -- it seemed very reasonable to me to take that time off and try to rest, try to strengthen everything and hope for a successful path forward. And everything up until that time in early March, there was every indication that he was doing great. The surgery, even though we have a high success rate, is not something that should be taken lightly. It results not only in significant downtime, but also, as with any surgery, there are risks.

"So it's not something you should jump into unless you feel like you do not have a better option....There was a possibility that he could start throwing again, get into games and have more discomfort. That's exactly what happened. So of course, you know it's a possibility, but it did not seem to me to be anywhere close to a certainty (that surgery would be needed) based on what I knew.''

The need to undergo major surgery comes as Sale was about to begin his five-year, $145-million contract extension given to him 12 months ago. That contract was questioned at the time, since it came months after Sale had dealt with shoulder inflammation, forcing him to miss more than a month toward the end of the 2018 season. He returned in September and pitched in the postseason as the Red Sox won the World Series, and despite a dominant ninth inning of relief to close out the Game 5 clincher, was clearly not himself (4.11 ERA in 15.1 innings).

With uncertainty hanging over the 2020 season due to the coronavirus, there's the possibility that Sale won't miss as many games as he otherwise might in a more ordinary season. Major League Baseball, in accordance with the Center for Disease Control, acknowledged earlier this week that games wouldn't resume any earlier than mid-May.

Commissioner Rob Manfred has said that every effort will be made to play a full 162-game schedule, with postponed games tacked on to the end of the remaining schedule. But increasingly, that looks less feasible, and given the rapid spread of the pandemic, a cancellation of the entire 2020 season can't be ruled out.

Even if that were to take place, Sale would almost certainly miss the start of the 2021 season. And Bloom added that the prospect of a shortened (or cancelled) season didn't impact the decision to undergo surgery.

"This would have happened either way,'' he said. "We knew, going back to the first flareup in March, that this was a possibility.''

Another unknown is whether getting the surgery performed could be made more complicated by the virus, with hospitals and medical personnel asking some to postpone elective surgery in order to more fully concentrate on those afflicted by the virus.

"Obviously, that's something we're mindful of,'' admitted Bloom. "Number one, the difficulty generally surrounding elective surgery, with what the country is going through and also making sure that we're able to do this that doesn't put any extra burden on the public health system. Those are considerations are we work to get this set up and get this done and we're going to make sure that we do it in a way that doesn't place any undue burden anybody who's suffering because of the outbreak.''

The loss of Sale for 2020 and beyond, however, will have a profound impact on the Red Sox for the near future.

In the immediate term, assuming the season resumes at some point, it will leave the Sox with a gaping hole in their starting rotation. Sale will be the third veteran starter to be lost to the rotation since the end of last year, joining Rick Porcello (free agency) and David Price (trade).

His loss leaves the Sox with just three proven starters: Nathan Eovaldi, Eduardo Rodriguez and Martin Perez. The Sox had been leaning toward Ryan Weber as someone who could fill a spot in the rotation, but were unsure about a fifth starter. They had left open the possibility that the club would utilize an opener to fill the final rotation spot.

In the bigger picture, it also calls into question whether the Sox should now view the 2020 season -- or what's left of it -- as an opportunity to strip down the roster and begin a larger rebuild for the future.

Having already dealt off Price and Mookie Betts for three younger players in a cost-cutting move, the Sox weren't expected to be contenders for the American League pennant. Now, the loss of Sale for the rest of 2020 and beyond could prompt a more thorough house-cleaning.

"I think Chris Sale is the type of player that you can't just replace,'' said Bloom. "He's an elite performer and those guys are hard to come by, so needless to say if he's unavailable to us for all of 2020, that's a big blow. Obviously, we have had a lot of things to consider over the last week-plus and we're in a little bit of a hiatus right now in terms of the schedule. So there's been a lot of other things on our plate. But obviously, it's going to make our climb that much harder.

"But as we've talked about since the beginning of the spring and before, it's never just about one season. We're always going to make sure we're looking to bolster our long-term outlook as well. Of course we want to do everything we can to compete this season and we still have that outlook. But we need to make sure that we're looking big picture as well. What that's going to mean as we go forward, it's hard to say (specifically) but needless to say, losing Chris for 2020 is not going to make our task any easier.''