Complicated elbow repair has Twins' Rich Hill back on the mound

Rich Hill is trying different ways to make hitters uncomfortable while contributing to a team that has high expectations this season.

That part hasn't been perfect, but the 40-year-old Twins lefthander is coming off an outing on Sunday against Detroit during which he held the Tigers to two runs over five innings and left the game leading 5-2 before the bullpen had a rare multiplayer meltdown.

The fact that the oldest pitcher is baseball is even able take the mound this season is an achievement. Faced with Tommy John elbow surgery last October that threatened to knock him out for all of 2020, Hill ended up being a candidate for different type of elbow surgery that got him back on a mound in nine months.

"Absolutely pleased with my elbow," Hill said. "Feeling zero issues the entire time through rehab, through the throwing program, through any outing this season. The elbow has been great.

"Continue to keep moving in that upward fashion, and again, it's the four days in between, making sure that I'm getting in the work that I need to get in. The training staff has done a great job."

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Instead of having Tommy John surgery, in which the ulnar collateral ligament is reconstructed using a ligament from a patient's forearm or hamstring and can knock a pitcher out of action for up to 16 months, a procedure called primary repair was used to strengthen the ligament instead of replacing it. A piece of tape that is coated with collagen is attached to the ligament and bone to assist in the repair and strengthening of the area. It is a less invasive surgery than the one named after John, the pitcher who was the first to have such a surgery in 1974. Therefore, the recovery time is shorter.

Given his age and desire to chase a World Series, Hill was all ears once he learned of the possibility of the surgery. He spent nearly three months on the Los Angeles Dodgers' injured list last season because of a left forearm strain and still had trouble upon his return.

But the primary repair surgery is still relatively new, going back to 2011, in comparison to hundreds of Tommy John surgeries being performed since 1974. Only a handful of baseball players, including pitchers Seth Maness and Jesse Hahn and outfielder Brandon Guyer, have had the procedure. Hill consulted with several of the nation's top orthopedic surgeons — including James Andrews, Neal ElAttrache and Timothy Kremchek — to learn as much as he could about the procedure. He also spoke with Maness and Guyer.

"I gathered as much information as I could, talked to maybe every major orthopedic surgeon in baseball," Hill said. "I think I talked to everyone across the country as far as orthos go. Understanding this has been a very successful surgery and I wanted to make sure the percentages were going in the right direction as far coming back as possible and making sure I would not be looking back and having something."

Still, he had to be the right candidate for the procedure. Each UCL tear is different. If the tear is in the middle of the ligament, the tape might not be effective. A tear off the bone is considered the perfect candidate for primary repair.

And a surgeon will not know if a ligament can be treated with primary repair until after he or she can open up the damaged area and inspect the ligament. A magnetic resonance imaging exam isn't enough.

"You can't look at it and say, 'I want that one,' " said Dr. Jeffrey Dugas of the Andrews Sports and Orthopedic Center in Birmingham, Ala. "You've got to fit the mold for it. You have to have the right tissue, the right injury, and that doesn't occur all the time. There are lots of people who still are better off with reconstruction."

Dugas performed the surgery on Hill, who previously had Tommy John surgery in 2011. Dugas took a look at the damage and determined primary repair was the way to go.

"Rich had previous reconstruction, so he had already had Tommy John surgery," Dugas said. "So he had more tissue than the average person who had never torn it before. He had his own tissue plus the graft. He had a ton of tissue to deal with.

"He had double or triple the amount of tissue."

On top of it all, Hill also underwent a stem cell injection, with the stem cells coming from his own bone marrow, to assist in the healing process. Hill stopped at nothing to get back on the mound this season.

On New Year's Eve, he signed with the Twins, getting a contract worth $3 million with bonuses for games started and innings pitched, with both sides understanding he wouldn't be ready until July. As it turned out, that's when the truncated season started, cutting Hill's base salary to $1.1 million in a 60-game season.

After his first start, he missed three weeks because of shoulder fatigue, working at the Twins' St. Paul training site to get back in the rotation. In five starts, he is 1-1 with a 3.86 ERA. He's been knocked out in the third and fourth innings in two of his outings, and opponents' line drive percentage of .290 is the highest against Hill in his career.

But Hill has spent his 16-year career adapting, being used as a starter with the Cubs, to being a reliever with the Red Sox, to being a starter again with the Dodgers and now with the Twins. And there was a stop in independent ball when things weren't working out for him.

Everyone knows Hill throws plenty of curveballs, a pitch with which he can change shape and speed. But he's broken out a cut fastball lately, throwing 18 over his past three starts. It's something else for hitters to think about and a pitch that could help him down the stretch in the heat of a pennant race.

Because that's what it was all about for Hill, getting healthy as fast as possible and getting another chance at the postseason while he still can.

"The last five years have just been an incredible experience of just being able to use that knowledge to now, where my body is strong and healthy again, to be able to continue to use that knowledge," Hill said, "and ultimately it is to win a World Series, and that's the biggest thing.

"Am I chasing a World Series? Yeah I am, and everyone here is chasing a World Series."