What's next for Shohei Ohtani, Angels after UCL tear?

This story was excerpted from Rhett Bollinger’s Angels Beat newsletter. To read the full newsletter, click here. And subscribe to get it regularly in your inbox.

NEW YORK -- It was shocking and gut-wrenching news, not only for the Angels and Shohei Ohtani, but for baseball fans across the globe.

But in a sobering press conference late Wednesday after being swept in a doubleheader, general manager Perry Minasian announced Ohtani was diagnosed with a torn ulnar collateral ligament in his right throwing elbow and won’t pitch again this season. It could necessitate a second Tommy John surgery ahead of his much-anticipated free agency.

Ohtani, the frontrunner to win the AL MVP Award despite the injury, has been the talk of baseball throughout the season and now there are questions swirling about his future. Here’s what we know right now:

When did Ohtani first start feeling something in his elbow?
Ohtani skipped his scheduled start against the Rangers last week with arm fatigue and also said he felt off on Aug 9 against the Giants despite not allowing an earned run over six innings. But Ohtani never indicated anything was wrong with his elbow until after he exited his start in Game 1 of Wednesday’s doubleheader, Minasian said.

The Angels aren’t sure if Ohtani sustained the tear on a specific pitch but his velocity noticeably dropped in the second inning. He left the game after throwing a 94-mph fastball with one out and immediately told the training staff about his elbow, which prompted imaging being taken between games. Ohtani found out the disheartening diagnosis but amazingly played in Game 2 of the doubleheader, which showed his incredible character and love for the game.

Ohtani, however, wasn’t made available to the media after the game to give an update on when he sustained the injury or if he felt anything in his elbow this season. But he should hopefully be available to the media soon to provide some clarity.

What’s the plan for Ohtani in the short term?
Ohtani traveled with the team to New York on Thursday and will remain the club’s designated hitter until he gets a second opinion on his elbow, a source told MLB.com. His agent, Nez Balelo, also flew from Los Angeles to New York on Thursday.

But it still hasn’t been determined whether Ohtani will play the rest of the season as a designated hitter, as it depends if he’ll need surgery. If he needs an operation, he’ll likely do it as soon as possible to get back on the mound quickly and it would end his season at the plate as well.

How likely is Tommy John surgery and what would the recovery time look like?
It depends on the severity of the tear and Minasian said he wasn’t sure the grade on Wednesday. But once Ohtani gets a second opinion, they’ll get a better idea if he’ll need a second Tommy John surgery.

Tommy John surgery is the most likely outcome for a torn UCL, however, and the recovery time is generally 12-18 months. But the success rate is lower for players who have had it twice. Even if he does make a quick recovery, he’d miss the 2024 season as a pitcher.

When Ohtani had Tommy John surgery the first time, he had the operation on Oct. 1, 2018, and didn’t pitch again until the shortened 2020 season. He made starts on July 26 and Aug. 2, 2020, and walked eight batters in a combined 1 2/3 innings before being shut down with a flexor pronator mass strain.

So there’s a chance Ohtani might not look like his normal self on the mound until 2026, and given the unpredictable nature of a second Tommy John surgery, there’s no guarantee he’ll ever get back to his pre-second surgery self. But given Ohtani’s proclivity for proving people wrong, it wouldn’t surprise anyone to see Ohtani defy the odds and pitch like an ace again.

And as a hitter, Ohtani only missed a month of the 2019 season after the operation, as he made his season debut on May 7. So, if Ohtani were to have the operation soon, he wouldn’t miss much time as a designated hitter. He didn’t fare as well offensively without being a two-way player but he also was dealing with a knee injury that required surgery in September 2019.

Are there other options?
There’s also a newer operation that repairs the UCL with an internal brace. It has a quicker recovery time of six to nine months but is generally used for partial tears and not full tears.

If it’s not a full tear, Ohtani could also opt for platelet-rich plasma (PRP) injections or stem-cell therapy. He did both in 2018 when he was first diagnosed with a UCL sprain before the season. But he still eventually needed Tommy John surgery.

Who are some other players who have returned from two Tommy John surgeries?
MLB.com has a list of notable players who have had the operation twice and examples include Nathan Eovaldi, Jameson Taillon, Mike Clevinger and Daniel Hudson. Jacob deGrom is currently rehabbing after a second Tommy John surgery, while Drew Rasmussen had success after a second operation with the Rays before tearing his UCL for a third time this season.

How does this affect his free-agent market?
That is the $500 million question and one we don’t fully know the answer to just yet, although this injury is going to hurt his future value. But Ohtani is still a unicorn and has been the best hitter in baseball this season. And if he has a setback with his pitching, he could be converted into an outfielder, which is a position he played in Japan.

But his contract could look much different now, as his agent will have to be creative. Will it have opt-outs? Pitching-related performance bonuses? Would Ohtani accept a one-year deal and then re-hit the market again once he’s ready to be a two-way player again?

It’s hard to know just yet but it’s another interesting wrinkle and the Angels could benefit, as Ohtani could feel comfortable with the organization as he rehabs his elbow. And his price could be a better match.