How elite pitchers have fared after having Tommy John surgery

It's too early to say how things will line up for Chris Sale when he returns from Tommy John surgery.Jim Davis/Globe Staff

With Tommy John surgery on the docket for Chris Sale, what kind of pitcher can the Red Sox expect beyond the 2020 season? Is it possible that the lefthander will return to dominance, or given that he’s turning 31 this month, will the Red Sox simply be looking to salvage something from the downslope of a once-elite career?

There aren’t a ton of pitchers who can claim anything resembling Sale’s track record — seven straight top-six finishes in Cy Young voting from 2012-18 — and were roughly the pitcher’s age (between 28 and 33) when they underwent Tommy John surgery.

But among the 1,722 players listed as having undergone Tommy John surgery since 2000 in a database maintained by Jon Roegele, there are six whose excellence and age harbored some resemblance to Sale.

How did those pitchers fare?

TOMMY JOHN

Using John as an example is cheating a bit, of course, since he underwent the procedure that came to bear his name back in 1974. But it’s worth remembering his profile, if only to recall the pioneer whose success made the surgery palatable to generations of pitchers who followed him.

John decided to take the plunge and undergo a novel procedure to repair his ulnar collateral ligament at the end of the 1974 season, in which he went 13-3 with a 2.59 ERA as a 31-year-old.

After he missed the 1975 season, he made a successful return in 1976 (10-10, 3.09 in more than 200 innings) before a remarkable run over the next four seasons: an 80-35 record, 3.12 ERA, nearly 250 innings per year, and three top-four finishes in Cy Young voting.

JOHN SMOLTZ

Smoltz was squarely in the middle of a Hall of Fame career when he blew out his elbow at age 32 in spring training of 2000. Just over 13 months later, he returned to the Braves rotation, but struggled to a 5.76 ERA in that role.

After a month on the sidelines, he returned as a reliever, a role in which he excelled over the next 3½ years (ages 34-37 seasons) before a return to the rotation at age 38.

Certainly, the Sox hope Sale’s future lies in the rotation, but the impact Smoltz made out of the bullpen in the four seasons that followed his surgery was considerable, with two All-Star berths and a top-three Cy Young finish.

In that vein, Smoltz offers evidence of how a great pitcher can remain elite after Tommy John surgery in his 30s, even as the initial decision to move him to the bullpen in 2001 points to the physical challenges of a return to a starting role.

CHRIS CARPENTER

Carpenter had a lengthy history of injuries throughout his 20s with the Blue Jays, but discovered renewed pitching life as a 29-year-old with the Cardinals, going 51-18 with a 3.10 ERA from 2004-06 and winning the 2005 Cy Young Award. But in 2007, at 32, Carpenter ended up getting midyear Tommy John surgery and made it back only for the very end of the 2008 campaign.

Over the next three years, from ages 34-36, he returned to form, going 44-22 with a 3.02 ERA, finishing as a Cy Young runner-up in 2009, getting named an All-Star in 2010, and anchoring the St. Louis rotation in a championship run in 2011.

TIM HUDSON

One of the most consistent starters in the majors over the first 10 years of his career, with sub-4.00 ERAs in eight of those campaigns, Hudson underwent Tommy John surgery in August 2008, shortly after turning 33. He came back in solid fashion 13 months later at the end of 2009, then produced three straight strong years for the Braves (49-26, 3.19) between ages 34-36 that included a top-four Cy Young finish.

ADAM WAINWRIGHT

Wainwright was a 29-year-old ace entering the 2011 season, coming off back-to-back top-three finishes in the Cy Young Award race, when he blew out his elbow in February. St. Louis nonetheless managed to surge into the postseason and win the World Series, all while the righthander sat on the sidelines. He returned in time for the start of the 2012 campaign but struggled to a 5.77 ERA through his first eight starts.

From that point forward, however, Wainwright was outstanding, forging a 3.43 ERA over his final 24 starts starting in late May (likely the early end of a projected return for Sale).

Then, starting in 2013 (his second full year back), he re-established himself as one of the top pitchers in the game, going 41-19 with a 2.61 ERA from 2013-15 — with two more top-three Cy Young finishes in 2013 and 2014 — before he suffered a torn Achilles’ tendon while batting in April 2015.

YU DARVISH

Darvish’s injury history with the Rangers leading up to his surgery in 2015 closely matched Sale’s with the Red Sox. He opened his career in Texas with three straight All-Star appearances (and a second-place Cy Young finish in 2013) in which he went 39-25 with a 3.27 ERA and 11.2 strikeouts per nine innings.

But in August 2014, Darvish was shut down with elbow inflammation. He went through an offseason progression that resulted in a clean bill of health, but then suffered his UCL tear in his first inning of the spring. His March 2015 Tommy John surgery resulted in a return about 14½ months later, in May 2016.

Darvish has now been back on the mound for four seasons, with mixed results. At times, he’s been dominant (he was an All-Star again in 2017), and in the second half of 2019, he had a 2.76 ERA with a ridiculous 118-7 strikeout-walk ratio in 81⅔ innings).

But overall, he’s had an up-and-down return both in terms of health (he’s averaged 126 innings per year) and results (24-28, 3.90 ERA, though with an impressive 11.0 strikeouts per nine innings).

WHAT DOES ALL OF THIS MEAN FOR SALE?

The elite pitchers of the last 20 seasons who required Tommy John surgery amid dominant runs came back to perform at solid to exceptional levels. Once they got through a fully healthy offseason, Carpenter, Hudson, and Wainwright all returned roughly to their prior levels of effectiveness, though it’s worth noting that all leaned heavily on the ability to generate bad contact and ground balls rather than outrageous strikeout rates.

As for the pure power pitchers in the group: Smoltz changed roles but his stuff remained elite in a way that continued him on a Hall of Fame path. Darvish has continued to post elite strikeout rates, though with diminished overall consistency, performing as an above-average starter but not a standout.

It remains to be seen which course Sale follows over the final four seasons of his five-year, $145 million deal. With surgery in front of him, the answer is unlikely to start to be formed until at least the middle of the 2021 season.