Félix Bautista could prove to need elbow surgery, but the Orioles aren’t ruling out the All-Star closer returning in 2023, executive vice president and general manager Mike Elias said Monday.
Bautista has a partial tear in his ulnar collateral ligament, an injury that sometimes results in Tommy John elbow reconstruction. But given the timing of the right-hander’s injury and the length of the procedure’s recovery, Elias said the Orioles are taking a “conservative approach” by attempting to have Bautista return rather than “diving into an operative procedure.”
“I think the fact that we’re keeping him throwing right now speaks to the fact that this is not over for 2023, and it’s just going to depend on how he feels as we keep this going,” Elias said before the Orioles’ series opener against the St. Louis Cardinals.
Losing Bautista, perhaps the best relief pitcher in the sport, for the remainder of the season would be a blow as the Orioles push to win their first World Series in 40 years. But the timing of the injury is also what is allowing Baltimore to attempt this unconventional approach.
Bautista hasn’t pitched since he injured his elbow with a 102.3 mph fastball with one strike remaining on Aug. 25 against the Colorado Rockies, but he’s played catch on flat ground three times in the past week.
“Again, it’s a situation where all the doctors that consulted us, our doctors, outside doctors, don’t see any irresponsible risk or loss of time if we’re to allow him to keep throwing right now and kind of seeing how it feels and what he’s able to do here the rest of the season,” Elias said. “But I think if we do get to the offseason, we’ll probably look at it through a fresh lens then. It’s something we’re going to have to think about what the best long-term move is for him.”
With the upcoming offseason and the likelihood that Tommy John surgery would likely keep Bautista out for all of 2024, Elias said the Orioles are hoping to utilize what the “calendar affords us” to potentially get their star closer back for the playoffs. The typical recovery time from Tommy John is between 12 to 18 months, meaning if Bautista would need the surgery, he would be projected to return for the start of the 2025 regular season whether he underwent the procedure now or after the 2023 campaign ends.
“When you’re talking about baseball injuries, there’s always three or four months in the winter that there’s no season going on. So if whatever you’re talking about is encompassing or overlapping those winter months, it’s time coming off the clock that you’re not missing games,” Elias said. “I think the timing was unusual. I think the nature of who he is for us and just him in particular makes this unusual. And every injury is a little bit different.
“Right now, the medical advice that we’re getting and that we’re comfortable with is this is a smart way to go right now, and if it leads to something else or it doesn’t work, we’ll still have those other options on the table and we’ll be no worse for the wear.”
Bautista was in the midst of a borderline historic season with an 8-2 record, 33 saves, 1.48 ERA and 16.2 strikeouts per nine innings. He was a rare Cy Young Award candidate as a relief pitcher, and his 2.8 wins above replacement on FanGraphs still leads all MLB relievers.
The Orioles don’t have a specific date to make future decisions about Bautista and his elbow. For now, they’re taking his throwing progression “day by day,” Elias said, and hoping he’s able to return this year.
“It doesn’t make sense to do this if it doesn’t seem like there’s any chance of him contributing the rest of the year,” Elias said. “I would still characterize this as something that we can’t count on, and we’re gonna take it very carefully and his career and his future and the team’s future are first and foremost in that.”
Elias said Bautista has not received platelet-rich plasma injections in his elbow, which in some cases have helped pitchers return from similar elbow injuries. The fifth-year executive was “purposely not being the one to talk like that” when asked about whether Bautista could need Tommy John surgery, but he did say the damage to the closer’s UCL does have “some significance to it.” It’s also possible Bautista could have a repair to his UCL, a less invasive procedure than the reconstruction, which replaces the ligament from another in the body.
“He did incur some damage here that I think at some point in time, whether this results in him returning the season or not, we’re gonna want to sit down and talk about what’s the best way to get this behind us with so much of his young career ahead of us,” he said.
Dr. Mohit N. Gilotra, a University of Maryland Medical Center orthopedic surgeon who treats shoulder and elbow injuries, , which begins in a little more than three weeks.
“If it was bad enough that he had to stop, which means it was hurting him to throw, to return, even if it’s the most minor injury, it would be unlikely, even in the postseason, right, because the postseason runs into November,” he told The Baltimore Sun over the weekend. “That’d be really unlikely. A lot of these protocols err on the side of caution, especially for someone like him, who’s so young and so good.”
Bautista, who the team has not permitted to speak with local media since his injury, is on board with the Orioles’ plan for him, Elias said. While the timeline gives the Orioles this opportunity to rehab Bautista for a potential return, it doesn’t change the fact that pitching through a partially torn UCL can be painful.
“He understands what happened to him, but he also understands the calendar, and we do have this little bit of chance to sort of keep him up and running right now,” Elias said. “He’s going to be the biggest determinant in where this goes and how.”
Baltimore Sun reporter Nathan Ruiz contributed to this article.
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