The Fate of Chris Sale’s Left Elbow

Disclosure: The co-authors of this post are lifelong, die-hard, pathological fans of the Boston Red Sox.

At this time of a global public-health emergency, we probably should not be distracted by things like this, but… Yesterday the Boston Red Sox announced that left-handed pitcher Chris Sale, one of the best hurlers in baseball, would undergo Tommy John surgery, otherwise known as ulnar collateral ligament reconstruction (see related Clinical Summary). This, by itself, is not surprising, because by some estimates, one-third of all Major League Baseball pitchers have that operation.

What puts the hitch in our windup is this: In August of 2019, Sale, who was experiencing his worst season ever stat-wise, received an injection of platelet-rich plasma (PRP) in his left elbow and was shut down for the rest of the season. Here we are, 8 months later, and he is facing a surgery that was veritably inevitable and could have happened then rather than now.

PRP has shown promise in treating some musculoskeletal conditions, but its effectiveness in elbow injuries is unproven at best. In response to a surge of research interest in PRP, JBJS recently published an article calling for standardization of PRP preparation protocols and more responsible reporting of methods and findings in the literature so that any positive findings can be replicated in future investigations.

No surgery date for Sale has been announced (most elective orthopaedic surgeries are being postponed to redirect resources to the COVID-19 pandemic), and we don’t know who will perform the surgery. What we do know is that this year is the first of a 5-year, $145 million contract for Sale. While it’s silly to use the words “schedule” or “timeline” for anything now, a best-case scenario would have Sale back on the mound in games in June or July of 2021. We are not privy to the terms of Sale’s contract, but we assume the clock on it is ticking, and several months of an elite pitcher’s career was wasted waiting for a treatment to work that is not backed by any solid science.

Click here for a compendium of JBJS content related to PRP.

Lloyd Resnick
JBJS Developmental Editor

Jason Miller
JBJS Chief Operating Officer

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2 responses to “The Fate of Chris Sale’s Left Elbow”

  1. Anonymous says :

    Excellent commentary by two non-surgeons on the scam that is PRP – another example of human gullibility. We all want a simple painless miracle cure for what ails us so fall prey to the unscrupulous promoter of unproven remedies.

    Like

  2. Anonymous says :

    I really don’t know what the science is behind the PRP, but the thought of regeneration through stem cells shows a great deal of promise theoretically. I’m waiting for research on stem cells for spinal cord injury. The risk versus benefit of trying this therapy in my mind seems reasonable. Just because this treatment did not work out, in this case, is no reason to discredit it. I do agree with double-blind studies, however. In like manner, we don’t have time to wait for double-blind studies to battle the coronavirus. We have a safe treatment for other viruses why not try it immediately and spare time and lives. Chris Sale was not hurt in any way by the treatment. Just my thoughts.

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