HOUSTON -- When Astros pitcher Lance McCullers Jr. was rolled into the operating room Tuesday in Los Angeles, he wasn’t sure what to expect when he woke up. He knew his right flexor tendon muscle was in need of repair, but there was a chance he would have to undergo a second Tommy John surgery, which would have been the worse outcome.

McCullers’ ulnar collateral ligament was in good shape, which was good news for the right-hander, and Dr. Neal ElAttrache repaired the flexor tendon and removed a bone spur that had been causing pain. McCullers originally injured the flexor tendon while pitching in Game 4 of the 2021 American League Division Series and admitted Saturday he’s been pitching through pain since. 

“I think [the surgery] addressed the issue I’ve had now for a couple of years,” he said. “Sad, a little bit disheartening. I wanted to be able to pitch and be out there with the guys, but sometimes things are out of our control.”

McCullers won’t have a good idea about when he might return to game action until he starts throwing again, which won’t happen until the fall. He won’t pitch again until 2024.

“I’ll follow the rehab protocol that ElAttrache puts forth with [head athletic trainer] Jeremiah [Randall], and I’ll have check-ins with him throughout the rest of the season, the summer and into the fall, and if he feels good about it, we’ll start throwing,” McCullers said.

McCullers chose rest and rehab after injuring the tendon during Game 4 of the 2021 ALDS. He made only eight starts in the regular season at the end of last year, going 4-2 with a 2.27 ERA, and started three games in the postseason.

When he reported to Spring Training, McCullers aggravated the injury while throwing in the bullpen on Feb. 14 and was still hopeful he could pitch 180 innings. His rehab had progressed early last month to throwing 35 pitches off a mound, hitting 93 mph, before he had a setback while throwing in the bullpen in May. 

“You never want to go in for surgery if there’s other options to exhaust,” McCullers said. “Even last year when I was pitching, it was still giving me problems and [I] obviously couldn’t handle the warmup in spring. I had a reinjury of the flexor tendon pretty bad a couple of weeks ago. At that point, ElAttrache basically said -- and our medical staff felt like -- [surgery] was the best option because we had run the course, and it was needed.”

McCullers missed the entire 2019 season after undergoing Tommy John surgery and returned to make 11 starts in the COVID-shortened 2020 season. In 2021, he was 13-5 with a 3.16 ERA in 28 starts before injuring his arm in the playoffs.

“I think anybody that knows me inside the clubhouse or personally knows how tough this process has been for me and currently is,” McCullers said. “I’m very frustrated. I know the fans want to see me out there pitching and providing my end of the bargain to the team. I feel a big responsibility to the Astros, to [owner Jim] Crane and to the fans to be out there and be pitching at the front of our rotation, and I haven’t been able to do that. It’s been a daily struggle, but I’m hoping this will be my last surgery and this puts me on a trajectory where I can get out there on a consistent basis like I was in ‘21 and be a great pitcher.”