Recovering from Tommy John Surgery

A pitcher’s first Tommy John surgery is considered a routine and highly predictable procedure. Roughly 80-97% of pitchers pitch again, with 67-87% of MLB pitchers being able to return to the same level of play (RTSP) within 15 months of the initial operation. Some pitchers who undergo TJ surgery actually learn to throw harder during rehab because they had both a successful procedure and trained in a way that essentially almost retaught themselves how to pitch.

While there can be success stories for the first TJ surgery, “if you have a second and third Tommy John surgery, your outcomes are worse. “It’s a longer return to play. It’s a lower likelihood of return to play,” Dr. Makhni said. “If we have to go back and there’s a loose piece of bone or fragment, it’s a lot of scar tissue and it’s much harder for the surgeon, the patient, and the recovery.” This is pretty evident with the numbers since only 77-85% of pitchers return to pitch with 55-78% of those pitchers ever returning to the same level of play.

The short list of players returning to the majors after their third TJ surgery includes Jason Isringhausen and Jonny Venters.

Hunter Greene’s Profile and Outlook

For Hunter Greene specifically, he is primarily a two-pitch pitcher with his fastball and slider being thrown to hitters 84% of the time in 2026. The sinker has an extremely similar movement profile to the four-seam fastball, so if you think the sinker is more of a misclassification of the four-seamer rather than a separate pitch, then the percentage of his primary two pitches being thrown goes up to 90%.

Predominately two-pitch pitchers can be quite effective as major league starters but this requires both pitches to be elite as well as having a decent put-away pitch as a third offering. Hunter Greene fits this mold perfectly along with other aces like Spencer Strider or teammate Chase Burns.

That being said, when pitchers experience their revisional TJ, the effects are significantly worse than after the first procedure. On average, pitchers after their second procedure lose one to two and a half miles per hour of velocity on their fastballs and their total workloads drop to half of what they were prior to their injury.  This is especially problematic for two-pitch pitchers because they cannot hide average stuff behind a wide arsenal. If Greene’s four-seam fastball drops from 98 to 96 mph then it becomes only two ticks faster than league average instead of four ticks. If this happens, then Greene will need to adapt to remain successful again as a big league starter.

The ways to become more effective as a pitcher with less stuff are through better command, tunneling (the ability to disguise pitches into making the pitches look like each other until the last possible second), or widening the arsenal. Command comes back from TJ later than stuff because command is a result of repeatability. Greene has been very effective at tunneling his pitches, but his tunneling ability is based more on his elite velocity than his ability to have his arm stay on the same plane and then break away. Since Greene’s four-seam fastball gets to the plate so quickly, he forces hitters to start their swings earlier which means he has not needed to disguise the slider to look more like the fastball. While it may be possible to change how the pitches move, this would be much more challenging then adding an extra pitch or two to his arsenal that blends in with his existing pitches. Perhaps this is a two-seam fastball or distinguishing the sinker more to get more arm-side run, or it could also look like adding a cutter or sweeper to act like a bridge pitch to prevent hitters from guessing between the two pitches.

The second factor to consider is usage. Greene’s career high innings total is only 150.1 IP. If pitchers after their second TJ pitch about half as much as before the surgery, then this would drop the maximum end of the threshold to around 75 IP, which starts to look more like the workload of a reliever. A move to the bullpen might not be the worst outcome for Greene and he could join other two-pitch closers like Mason Miller or Edwin Díaz as a best-case scenario. A shift to the bullpen could solve any velocity dips since he would not have to conserve energy over a longer outing.

In other words what I see in Greene is someone who
1) Has Elite stuff on the mound and generates tons of K’s
2) Has massive injury red flags and 12+ months away from pitching at the major league level (will likely be 29 when he returns to the mound)
3) Has reliever risk
4) Should add another pitch in the arsenal to remain as a starter

When I see a pitcher 12+ months away from returning to the majors with questions in terms of stuff, health, and workload, this puts Greene for me in dynasty leagues in the same category as prospects. I really like that he has demonstrated success in the majors, and I always value the player who has proven it at the major league level over an unproven prospect. That being said, I also recognize that if he is 29 when he returns to the majors with major injury questions, then that will limit the longevity of his remaining career.

Future Fantasy Value

When asking the question of Greene ‘s value in dynasty leagues, I would certainly prefer a high ceiling but currently I’d look at healthy prospect like Travis Sykora or Kendry Chourio who could be frontline aces and are much younger than Greene. On the other side I would definitely rather have Greene in dynasty leagues than a pitcher struggling with consistency on the field like Luis De León. When it comes to comparing Greene to someone like Jamie Arnold or Gage Stanifer in dynasty leagues, it becomes “do I take the player who has done it before in the majors” vs “do I take the healthy player who could be in the majors for more years if it all clicks”. I would lean Arnold over Greene because Arnold has SP2/SP3 upside without the health concerns. As for Greene vs Stanifer, which player I prefer depends on the depth of the format. In 12-15 team dynasty leagues, I would chase Greene for the ceiling, whereas I would take the higher floor of Stanifer in those deeper leagues where finding playing time becomes all too important.