Fantasy Quandary: The Alex Rodriguez Hip Surgery

We have all heard by now that fantasy baseball’s best (or second-best, depending who you ask) third baseman—and first round lock—is going to miss somewhere between the next six to nine weeks following arthroscopic right hip surgery to repair a tear in the Acetabular Labrum and to correct impingement-causing bone changes. While a great number of authors on various sites have pretty much declared Alex Rodriguez to be undraftable (I called him a “major risk”), there are likely just as many managers out there who are strongly considering him for an early or mid-round selection (especially in head-to-head leagues with DL spots). The aim of this article is to describe the anatomy, the surgical procedure, implications for the baseball athlete, and the resulting fantasy scenarios that have arisen from the situation.

The History

In a physical examination during spring training, Yankees team physician Chris Ahmad advised Rodriguez to seek consultation with renowned hip specialist Dr. Marc Phillippon. As a result, it was found that he had a tear in his labrum, as well as a cyst on the labrum that needed to be drained. The cyst was the minor aspect of his condition, and was a secondary result—not the cause—of the labrum tear.

Initially, the Yankees reported that Rodriguez would opt to play out the season with the stiffness in his right hip, choosing conservative rehabilitative efforts and anti-inflammatory medication over invasive surgery that could have potentially sidelined him for upwards of four months.

The decision to go the conservative route did not last long, however, as it was reported shortly after he had the cyst drained that he would undergo arthroscopic surgery that would allow him to return during the season, and would, in essence, partially correct his hip problems.

The Anatomy

Here is a fantastic illustration of the Acetabulum and the Labrum (from the Journal of the American Physical Therapy Association Website). The labrum is a rim of fibrocartilage that lines the rim of the hip socket that reduces contact stress and provides stability (1) to an already deep and stable hip joint by increasing it’s depth by 21 percent. It is wide and thin in the front, and thick in the posterior aspect. Due to poor blood supply, the labrum often requires surgical repair to approximate the torn edges. The outer one-third of the labrum has limited blood supply, so small, focal tears to these regions may heal over time with rest (not typical).

If left untreated, the rate of degeneration of the hip may increase, likely leading to the early need of hip replacement or resurfacing procedures. The labrum is usually torn with sports and activities that require repetitive twisting and rotation with the hip—especially when combined with axial loading (weight bearing) and rapid hip flexion and extension.

The Effects on Rodriguez’s Game

A-Rod’s tear is in the posterior labrum, which is often torn with repetitive hip extension combined with abduction and external rotation—much like when a third baseman/shortstop must push off forcefully to get to a hard hit for a backhand attempt. It may also be torn by axial loading combined with forceful rotation; such is the case with the act of swinging the bat.

We may see hesitance at the plate when he returns, so you can probably expect a decline in his power numbers this season once he returns. He may also struggle to hit pitches on the inner half of the plate, which requires greater pelvic rotation (and hence, hip rotation) to get the bat through the zone. In addition, the Yankees will likely decide to run Rodriguez less frequently as well, leading to much lower stolen base numbers.

Here is a nice illustration (from the New York Times) that describes the hip labrum and shows how the labrum is affected by baseball activities.

The Surgery

Dr. Marc Phillippon performed surgery on Rodriguez on Monday morning in Vail, Colo. The procedure was a “hybrid” surgery that would allow for him to return to the field sooner than later. Phillippon expects him to be out for six to nine weeks. Brian Cashman reported today that he expects Rodriguez to return to game action “sometime in May.”

Monday’s surgery—the first in a series of two—included a labral repair (sutures are used to repair the tear), debridement (as is standard in arthroscopy), and a small “Pincer” impingement trimming. This is where there is osseous (bone) malformation on the rim of the socket that needs to be smoothed down to prevent pinching and discomfort in the hip. It also allows for the hip to extend (in this case because it was in the posterior aspect of the joint) more smoothly and without painful interruption.

A-Rod will still need to have an additional surgery in the offseason to address the “Cam” impingement (Femoral head against the socket). Sometimes in a hip arthroscopy, the surgeon will find bone spurs that grow along the rim of the Acetabulum (hip socket) that create Femoroacetabular impingement, and can also lead to further labral tearing, cartilage degeneration, cyst formation, and pain. Dr. Phillippon said that Rodriguez would “absolutely” be ready for the start of spring training in 2010.

The offseason surgery will be reserved for any additional repair of the labrum (if needed), and to address the “Cam” portion of the impingement, which is located on the Femoral head. Sometimes, this includes chondroplasty or microfracture procedures, depending on the extent of damage.

Fantasy Implications

Previously, I had written that I would not be taking A-Rod early in fantasy drafts even if he did not opt for surgery: “For what it is worth, I am not going to be drafting A-Rod in the first round. Given this news, I probably would not draft him unless he drops to the third round or later (which probably won’t happen), so it looks like I will not have A-Rod on any of my teams in 2009.”

Well, now I won’t be taking A-Rod before round five. If he fell to round six or seven, I would snag him and hope for the best, but I won’t be gambling on my core of players from the first five rounds. The decision to draft A-Rod also largely depends on the format of your league (H2H vs. Roto), roster size, and DL spots. In H2H leagues with ample DL spots, you could try to wait and draft A-Rod in the third, fourth, or even fifth rounds, and stash him on your DL until he returns. In roto leagues, where cumulative stats are the name of the game, you probably would be best served to wait a couple of rounds later if you decided to draft A-Rod at all.

The best-case scenario has A-Rod returning in late April or early/mid May. Even then, there is no guarantee that he will be completely pain-free, though he should be more comfortable. Remember, he will still have some structural restriction remaining from the “Cam” impingement that is to be addressed in the offseason.

The fantasy impact also extends to the rest of the Yankees lineup, particularly to new addition Mark Teixeira. Tex will no longer have A-Rod’s bat in the lineup, which will take away some favorable pitches, but he is certainly no slouch at the plate either. While his RBI totals will rise over the first month-plus, it is uncertain how the lineup will play out once A-Rod returns. It is probably 50-50 as to whether Teixeira hits in front of or behind Rodriguez.

In the meantime, Yankees fans will have to get used to seeing Cody Ransom over at the hot corner, unless they go out and acquire a more proven veteran.

Projections for Alex Rodriguez in 2009

He will likely miss all of April and part of early May. Even when he returns, he will likely exhibit a decrease in power, batting average, and stolen bases. It is also not out of the realm of possibility that his hip acts up and sends him to the DL at some point when he returns. These hip procedures tend to be finicky at times, especially when work is done to the bone. Also, remember that he still has some areas of deficiency in the hip that will need to be addressed in the offseason. If the Yankees fall out of contention somehow, A-Rod may be shut down early so that he is more likely to be ready for spring training in 2010.

My preliminary forecast for the balance of the season is .282/.378/.505, 21 HR, 70 RBI, and 5 SB.

References

(1) Tan V, Seldes RM, Katz MA, et al. Contribution of acetabular labrum to articulating surface area and femoral head coverage in adult hip joints: an anatomic study in cadavera. Am J Orthop 2001;30 :809 –812.