Orioles pitcher Tyler Wells undergoes elbow surgery with potential for quicker recovery than Tommy John

Tyler Wells’ career with the Orioles began, in part, because he underwent surgery to repair a torn elbow ligament. About five years after that first procedure, Wells has now received a second.

Wells went under the knife Monday to have his ulnar collateral ligament repaired a few weeks after the club announced he would be out for the remainder of the season. But, unlike his first procedure that came before Baltimore selected him in the Rule 5 draft, Wells did not undergo Tommy John elbow reconstruction, the most common surgery to fix the UCL.

Instead, Wells opted for the internal brace procedure, a new Tommy John alternative that is gaining popularity among MLB pitchers because of the potential for a shorter recovery time. The average recovery from Tommy John is approximately 14-to-16 months, while it’s about 12 months for the procedure Wells underwent.

The internal brace procedure repairs the UCL and then reinforces it with a tape-like suture instead of fixing it through a full reconstruction like Tommy John, which replaces the existing ligament with a graft usually taken from the pitcher’s hamstring tendon. Pitchers with fully torn UCLs aren’t logical candidates to receive the internal brace procedure, but those whose ligaments are only partially torn are increasingly opting to take their chance with the new surgery.

It’s also becoming more common for pitchers undergoing a second UCL procedure, known as a revision, because a second Tommy John surgery normally results in a longer recovery and a lower success rate. Since the internal brace procedure is new, the date behind its effectiveness is unclear. John Means, the Orioles left-hander who is also out for the season because of a UCL injury, had his second Tommy John surgery earlier this month.

Dr. Keith Meister is one of the leading surgeons for internal brace procedures. He performed both Means and Wells’ procedures at Trinity Park Surgery Center in Arlington, Texas.

Lucas Giolito and Spencer Strider are among MLB pitchers who recently elected for the internal brace. Meister performed Strider’s surgery this spring, and the Braves hope that the hard-throwing right-hander is back early next season. The surgery was a revision for Strider, who had Tommy John surgery in 2019.

It’s unclear what the Orioles view as Wells’ timeline, but it’s possible given the quicker timeline the internal brace procedure can produce that he is able to return to the mound next summer.

Wells missed the 2019 and 2020 minor league seasons as a member of the Minnesota Twins organization because of his first surgery. That made the 6-foot-8 righty an under-the-radar target in the Rule 5 draft heading into the 2021 season, and the rebuilding Orioles took a shot on him. Wells pitched out of Baltimore’s bullpen that year, even serving as the club’s closer in September.

A starting pitcher by trade, Wells returned to that role in 2022 and was the Orioles’ best in the first half before having his second half derailed by multiple injuries. He was an All-Star-caliber starter in 2023’s first half, leading the American League in WHIP, before he ran out of gas in July and returned to Baltimore in September as a dominant back-end reliever, closing out the club’s AL East title-clinching win.

Wells, who has a career 4.06 ERA, opened this season in the Orioles’ rotation because Kyle Bradish and Means were on the IL with elbow injuries. Bradish returned in May but is back on the shelf with a sprained UCL.

After three starts, Wells was placed on the IL with elbow inflammation. Manager Brandon Hyde said it was for “precautionary reasons.”

“We’re really confident he’s going to be OK and it’s not going to be too long,” Hyde said in April.

But Wells’ attempts to begin a throwing program ended in discomfort, so the organization decided surgery was the best course of action. Wells has three more years of arbitration remaining before he hits free agency.

In 2023, only seven Orioles pitchers spent time on the injured list as the club ended the season with the fifth-fewest IL days in MLB. Less than halfway into the 2024 campaign, they’ve already had seven pitchers land on the IL: Cionel Pérez, Grayson Rodriguez, Dean Kremer, Danny Coulombe, Bradish, Wells and Means. Despite the injury issues, the Orioles sport a 3.07 ERA that ranks second-best in the major leagues.

Around the horn

• The Orioles on Monday claimed right-handed pitcher Nick Avila off release waivers from the San Francisco Giants, optioned him to Triple-A and placed him on the IL. The Orioles’ 40-man roster is full, although Wells can be moved to the 60-day IL to create a spot in the future. Avila made his MLB debut with the Giants this year and posted an 8.49 ERA in 11 2/3 innings. He went 14-0 with a 3.00 ERA in 72 innings for the Giants’ Triple-A affiliate last season.

• Yankees manager Aaron Boone announced that starting pitcher Gerrit Cole, the reigning AL Cy Young Award winner, will make his season debut against the Orioles on Wednesday in New York.