The Phillies and Chase Utley Should Explore Non-Traditional Surgery

Note: This article was written last spring when news first circulated about Chase Utley’s injury. I chose not to publish it as it seemed as though the Phillies and Utley had figured out a course of action and probably my own foolish optimism.

Twelve months later, with no progress and apparent issues now in both knees, this article seems especially relevant. For sake of continuity I have changed little about the article aside from pertinent facts about Chase Utley and the status of his injury. All edits are in italics throughout the article.

Chase Utley’s knee has become the talk of Philadelphia sports. Forget the rising crime right across the river in Camden, the losing skid of the Villanova Wildcats or the surprising play of the Philadelphia Sixers; it would appear the happiness of Philadelphians is contingent on the knees of their baseball team’s second basemen.

There are more than a few potential remedies for patellar tendonitis, which has sidelined Utley for the entirety of this spring training and much of last season, but none appear to be an answer. Now Utley and Phillies are in the unenviable position of making a decision for which there appears to be little upside.

Working in the healthcare industry, I’ve come upon countless cases of tendonitis and in only a very few of those cases have doctors determined that surgery is the best decision.

So why would the Phillies consider surgery in this case?

Utley has experienced chronic patellar pain for an estimated 30 months, and one can assume most conservative approaches to treatment have been exhausted. The knee has not responded well to cortisone injections, and the Phillies trainers seem to have run out of options.

The problem with surgery and the reason Chase Utley and the Phillies should use it only as a last resort is two-fold.

Surgery is typically reserved for patients with debilitating tendonitis. That is to say, when a person can no longer walk, then and only then is surgery a truly viable option. However, athletes often consider surgery when their professional livelihood is at stake, which the Phillies and their 33 year-old second basemen must feel is the case.

Still, surgery should not be the only option they are exploring for the simple fact that surgery is not a sure thing.

The standard procedure for relieving the pain of patellar tendonitis in the U.S. (and the one the Phillies are deliberating) is knee debridement, a relatively non-invasive procedure where the surgeon cleans out (shaves) the myxoid degeneration of the knee.  Within weeks, patients can be back on their feet but by and large, the condition shows itself again within several months (or even less for athletes).

In short, the knee debridement surgery is only a band aid and not a very effective one.

In fact, a doctor in New York, who was nice enough to humor me (on the condition that I didn’t mention him by name), said me that he’d recommend athletes never consider this procedure because it is only a “very temporary solution that typically leads to follow-up after follow-up repeat debridement procedures” and normally leads to a worsened condition of tendonitis due to the constant exposure of the knee.

Normally, the doctor said, debridement is about 60% successful for a patient who has the surgery and follows it up with well monitored physical therapy. However, for an athlete, he wouldn’t even offer a success rate. His only advice was, “I would not recommend it.”

This must be where the Phillies are—between a rock and a hard place. So I asked the same doctor at this New York surgical hospital, “What would you recommend?” He suggested among other things, orthotics (to support the arch and absorb more of the shock usually put on the knee), extracorporeal shock wave therapy (a method of sending shock waves to heal and strengthen tendons) and the always popular but, in Utley’s case, ineffective cortisone shots.

It can be assumed the Phillies training staff (ranked among the best in MLB) has considered these alternatives, so I pushed the doctor further and asked if Carmelo Anthony, the (then) new star forward for the Knicks and noted sufferer of patellar tendonitis, had exhausted all the options available to him, what would he suggest? (I assumed he’d rack his brain for good advice in the case of a hometown player.)

He suggested a less traditional surgery (that has been very successful and growing in popularity) practiced in England by a Dr. David P. Johnson at the Bristol Orthopaedic & Sports Injury Clinic. The doctor has performed this surgery on about a dozen or so professional European soccer players and about 30 other patients with a 90% success rate.

The procedure in short, from the Bristol Clinic’s website:

The technique included elevation and partial excision of the superior central part of the fat pad to reveal the bare area of the patella. Elevation of the patella tendon fibres from the anterior 5 millimetre surface of the inferior pole of the patella, and excision of the exposed inferior pole.

The procedure practiced by Dr. Johnson (the European equivalent to Dr. James Andrews in Mississippi) is a same-day surgery with a nine-week recovery time and, in the case of his athletes, a return to action in 13 weeks. Dr. Johnson is not the only doctor to utilize this procedure but apparently has had the greatest amount of successful cases.

This surgery is not ideal since it would put Chase Utley on the shelf for essentially the entire 2012 season. Of course, 90% success means that 10% are unsuccessful, but the Phillies, Utley and the fans need to understand that tendonitis does NOT go away and will only worsen.

However, if it works on athletes who run on a 110-yard field for 90 minutes at a time for nine months out of the year through the blistering heat of Southern Hemisphere summers and bitter cold of northern England winters, it would seem to be a great solution for a baseball player.

Additionally, to get a 100% healthy Chase Utley back at 34 years-old with a fresh knee and a year of rest is a sacrifice the Phillies may need to consider in their long-term plans for success.

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Nyjer Morgan Could Be Philadelphia Phillies’ Missing Link in 2011

This spring, there has been plenty of consternation in the Phillies organization and around the Phillies fan nation.

Seemingly everyday a new concern arises, whether it’s Chase Utley’s knee, Dominic Brown’s hand, Placido Polanco’s elbow, etc. Adding Luis Castillo will certainly give depth to the infield, but what about the outfield?

Today, reports are the Phillies are actively looking to acquire a veteran outfielder who would be able to backup Shane Victorino in center field. At the same time, scouts who cover the Washington Nationals are writing that the team is actively shopping center fielder Nyjer Morgan. One scout even said, “They’re trying to give him away.”

Phillies fans should be very familiar with Morgan, who’s spent the last two seasons in Washington. He is known for his defense, speed and fiery attitude (no surprise for a former Canadian junior hockey leaguer).

Questions about his temper and discipline are well founded, as he has had more than his fair share of brush-ups with opposing pitchers.  However, what seems to be lost is just how productive he has been in four seasons while playing for perennial losers, Washington and the Pittsburgh Pirates.

Excluding last season, Morgan has been better than average at the plate hitting .305 (.283 overall) with a .344 OBP and .704 OPS. He is also a great base-running threat, averaging 33 steals since 2009.  Most importantly, he is a solid center fielder.

In evaluating his team this spring, Charlie Manuel has reiterated again and again that his team needs to get back to playing small ball. Since 2008, they’ve had no need to utilize this practice. But the loss of Jayson Werth in free agency and the uncertain return of Chase Utley has forced the team to re-think their strategy.

Playing small ball means getting men on, advancing by stealing, employing the sacrifice bunt and resisting the urge to swing for the fences. In short, Manuel is hoping his team starts manufacturing more runs.

Morgan is the epitome of this style of play. He steals bases, bunts for hits and has only hit four home runs in his career.

Morgan would be a great situational player and platoon option for the Phillies. Considering he’s at his best against right-handed pitching (.333 average), he could be an invaluable substitute for Shane Victorino who hits a lowly .233 against righties. Furthermore, the Phillies have the oldest starting lineup in baseball; it is necessary to add depth and protect their aging stars.

While the Phillies’ payroll has soared north of $170 million this year, and general manager Ruben Amaro has said repeatedly that there is no more money to spend, Morgan’s $427,000 salary would be manageable—especially considering they’d have to trade a contract to acquire him.

The Nationals certainly won’t give up Morgan for nothing, but the team appears comfortable with Rick Ankiel at CF and need to make room for future outfielder and hot prospect Bryce Harper.

This comfort, and the Nationals’ apparent disillusion with Morgan, should be all the Phillies need to inquire about his services.

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Jayson Werth Knows He’s on His Way Out of Philadelphia

Call it J-Werth’s Senior-itis

The second semester of my senior year of high school I eschewed four years of perfect attendance, relegated studying to only that of the opposite sex, and made it a point to live it up at any and every moment because I knew, “Hell, I’m not going to be here in five months.”

I concerned myself little with what colleges might think as I a) had gotten into school and b) knew future colleges and employers would excuse a few months of truancy for the 17 years of hard work I’d put in.

Jayson Werth is in his Senior Semester with the Phillies and his performance and actions seem to suggest he’s got the senior-itis.

Let’s get the objective stuff out of the way. He’s batting average has dropped 103 points, his OPS 306 and his slugging percentage 371. Even that seems to belie Werth’s epic struggle.

In the month of July (54 at-bats) he has three RBI. The only number Werth has been able to keep steady are his strikeouts. He’s leading the team, averaging 23 per month and is well on his way to more than 30 swing-and-misses this month.

And those are only the cut-and-dried blunders that seem to be barreling down on the “Werewolf.”  (By The Way; shouldn’t that be spelled “where”wolf or “ware”wolf?)

A month ago Jayson was easily the most popular Phillies player, especially among women.

With seats just rows away from the right-field where Werth plays, I’ve been privy to the seemingly endless number of signs and admirers.

“Fear the Beard”

“Take Off Your Shirt / I’m Werth It”

“Sign the Man”

 “I’m Having Your baby”

If there were a rock star on this team, he stood 6’5″ with a beard that might have made Jim Morrison ‘69 jealous.

So what happened? It began innocuously, seemingly silent, odorless and invisible. Now the boos and catcalls have started to become audible and it is clear to everyone that the “Werewolf” is no longer under a full moon.

He’s cursed out fans, been the target of post-game lectures from Charlie Manuel, has been short and irate with reporters, was the victim of a now de-bunked rumor involving him and Mrs. Utley; and today came under scrutiny again as it became public knowledge that he was out until 3 a.m. (earliest reports) gambling in St. Louis with the injured second baseman.

You may say, it’s the result of living under a spotlight, right? Not for Werth, who has seemed to embrace his hard partying, rock star image without become front page news for the rumor mills.  Well, let’s add two headlines to that rumor mill right now.

“Jayson Werth Has Mentally Checked Out on This Team.”

“Werth Will Not Wear A Phillies Uniform in 2011”

Give him credit for dragging around Sisyphus’ boulder of burden (remember the Stonecutter episode of Simpsons?). His contract had to weigh on him this year.

But as he started out hot (hitting .325 in April) the weight of pending free agency probably felt like nothing more than a pebble.

However, the average dropped as did the power numbers, rumors started, and worst he’s seemed to develop a paralyzing fear of swinging the bat in two-strike counts.  

So now it’s a “F— It” situation. He’s put in three years and three months of solid MLB experience. Made an All-Star team and started on two World Series teams.

If the Phillies were going to re-sign him, they wouldn’t be shopping him loud and clear. Furthermore the Phillies’ organization knows if they don’t sign him, they have to trade him, as Ruben Amaro knows he’s in a position not to show minus points in any transaction.

Thus, Werth’s early-season pebble has grown into a boulder.  We don’t have to admit it, but Werth, the Phillies, and deep down, we the fans know that they we’re watching the sun rise on the Werewolf.  

 

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