Why didn’t Andrew Painter have Tommy John surgery in March?

The Philadelphia Phillies announced Wednesday that No. 1 prospect Andrew Painter has been recommended for Tommy John surgery to repair the partial tear that he has in the UCL in his right elbow.

Painter will visit with Dr. Neal ElAttrache — the same doctor who performed Bryce Harper’s Tommy John surgery — Monday in Los Angeles for a consultation. The expectation is that Painter will undergo Tommy John surgery on Wednesday, if ElAttrache agrees with the assessment that the procedure is indeed the best path forward for the 20-year-old.

“We’ve treated him conservatively,” president of baseball operations said Wednesday afternoon at Citizens Bank Park. “We’ve made progress at times. He’s thrown, it’s felt good at times.

“But unfortunately, he’s had a reoccurrence of pain and we just feel it’s time — the doctors have looked at him — to move forward and have the surgery in our doctors’ recommendations and feelings at this time. And then Dr. ElAttrache will be the second opinion on that.”

With much fanfare, Painter pitched two innings for the Phillies in a Grapefruit League game against the Minnesota Twins on March 1. Still a teenager at the time, Painter peaked at 99 mph and was so impressive that Minnesota’s shortstop Carlos Correa proclaimed that “this kid’s going to be a star.”

And Painter may still very well fulfill his potential, but two days after his Spring Training start, the Phillies said he was undergoing tests as he dealt with elbow tenderness. The tenderness turned out to be a UCL sprain (partial tear), and the Phillies and ElAttrache opted to have Painter rest and rehab the injury. Just over four months later, it appears that Painter is headed for Tommy John surgery on the elbow.

So why didn’t Painter just have the surgery in March, which would have put him on a quicker recovery path?

“Basically it’s always a scenario that they feel that if they can possibly treat it out [that’s the preferred path],” Dombrowski said. “There was some healing process and some of the results that they’ve had from the imaging [show that] there has actually been healing.

“But it’s still bothering him. But you never know that until you go through the process. So that’s almost always [the route], unless there is a complete tear and he does not have a complete tear.”

There are examples of pitchers who have pitched successfully with partially torn UCLs, such as Masahiro Tanaka with the New York Yankees. But at least anecdotally, the rest-and-rehab approach doesn’t seem to have worked for Phillies pitchers with UCL injuries. Cliff Lee and Seranthony Domínguez are two notable examples, and Painter now joins that unfortunate club.

But this approach isn’t unique to the Phillies. Perhaps one day there will be better technology that will help doctors to more accurately determine at the time of injury whether resting and rehab could realistically help an injured pitcher avoid surgery. For now, this is where science is at. It wasn’t just the Phillies who felt Painter should attempt rest and rehab when he initially injured himself in March, it was also ElAttrache, who is viewed as the preeminent expert on such matters.

Painter will now miss the entirety of 2023 and almost certainly 2024 as well. Perhaps in 2025 — which will still only be his age-22 season — Painter will return and make the impact the Phillies hoped he would in 2023.

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