In the coming weeks, the Twins will determine the fate of righthander Kyle Gibson, the latest pitcher to go down with a partially torn ulnar collateral ligament.
The surgery to repair that ligament is named after its first recipient, Tommy John, who prolonged his career after having his elbow repaired. So many pitchers have come back from Tommy John surgery to pitch well that shoulder surgery is considered to be a greater risk for an abbreviated career.
Observers are curious to see how the Twins proceed with their top pitching prospect.
Based on your e-mails, armchair surgeons want Gibson under the knife immediately. Twins fans probably are going on precedent, as rehabilitation for Francisco Liriano and Pat Neshek didn't go well and both ended up on the operating table anyway.
In 2008, Neshek tried to rehab for three months after injuring his elbow in May. He didn't get operated on until November. In an e-mail, he wrote he regrets not having surgery right away because he ended up missing 10 months of regular-season baseball.
"For me, if I had anything resembling what I had before, I would opt for surgery ASAP," wrote Neshek, now with the Padres. "Waiting around was a mess and it really set me back. ... I really felt forgotten, and I think being alone doing rehab for two years was not a positive thing."
There are more recent precedents. Seattle's David Aardsma, Oakland's Brett Anderson and Philadelphia's Jamie Moyer all tore their UCLs, all tried rehab and all ended up having Tommy John surgery.
But Arodys Vizcaino's case suggests rehab can work. He suffered a partial tear of the UCL last year, rehabbed, returned by the end of the year and recently made his major league debut for Atlanta after striking out 100 batters in 97 innings in the minors.
Another rehab-over-surgery winner was Nolan Ryan -- but he was one of the great physical specimens of all time.
And Joe Mays is an example of how surgery didn't work. The former Twins righthander, an All-Star in 2001, elected to have Tommy John surgery and missed the 2004 season. He never regained his velocity, and the Twins let him go as a free agent.
Gibson, in a text message, said he is working on strengthening his shoulder and forearm. There is a chance he will seek a second opinion, which is the right thing for him and the Twins to do because he is such an important part of the team's future. Their first-round pick in 2009, Gibson has the stuff to one day become ace of the Twins rotation.
If doctors agree that rehab is the way to go, then Gibson has a chance to ready for 2012. The key will be in two or three months, when he would be expected to climb on a mound and let it loose to see if rehab worked.
If rehab fails, then he would have surgery. That's not a catastrophe, since an early November surgery could put him on line to contribute in 2013, as recovery from Tommy John surgery is about 16 months.
The worst-case scenario is that Gibson lets it loose during instructional league and feels great, tries to pitch in 2012 and reinjures himself. Then surgery would likely take him out for all of 2012 and most of 2013, basically costing him two seasons.
It's a case worth monitoring.