Venters undergoes second “Tommy John” surgery

Braves reliever Jonny Venters underwent a second ligament-transplant surgery on his pitching elbow Thursday, realizing the worst-case scenario for his lingering elbow pain.

The operation performed by Dr. James Andrews in Gulf Breeze, Fla., confirmed that Venters had a partial tear in his ulnar collateral ligament and required the second “Tommy John” surgery of his career.

Andrews used a graft from his hamstring to repair the ligament and removed a bone spur Thursday morning. He used a graft from Venters’ wrist when he performed the transplant surgery in 2005, when Venters was a 20-year-old minor leaguer.

Now Venters, 28, will miss the rest of the 2013 season and at least part of 2014. A second “Tommy John” surgery raises questions about Venters’ ability to pitch at a high level again, but the Braves came away hopeful that he can come back after a 12-month rehabilitation.

“We’re encouraged based on what Dr. Andrews had to say post-operatively,” Braves general manager Frank Wren said. “It’s a one-year rehab, and he’ll have a better idea as he goes through that process — as you would with any Tommy John surgery.”

Success rates for first-time ligament transplant patients are high, and pitchers typically come back in about 12 months, as Tim Hudson and Kris Medlen did, and Brandon Beachy is on target to do in June. The overall success rates aren’t nearly as high, though, for repeat transplant patients. Though the sample size is smaller, estimates range from 10 to 25 percent of those pitchers returning to be effective major leaguers.

Saturday’s starter for the Dodgers, Chris Capuano, 34, provides Venters some encouragement. He is in his fourth season back after “Tommy John” surgeries in 2002 and 2008.

“It really is an individual outcome based on the player and his body and the rehab and all those things,” Wren said. “But there are players who have actually pitched better after their second than they did after their first. There are players that have not. I don’t know that you can say for certain how a player is going to come out.”

Among other pitchers to make it back after repeat-transplant surgery are Doug Brocail, who pitched six seasons after a second operation at age 35; Al Reyes, who pitched two seasons with Tampa Bay after a second operation at age 34; and Jason Isringhausen, who had “Tommy John” surgery three times and pitched until he was 40.

Jose Rijo had five ligament-transplant surgeries and missed five seasons before coming back with the Reds at age 36. He made 44 appearances over his final two seasons.

Venters hoped to avoid surgery after having a platelet-rich plasma injection in his elbow April 2 and resting for four weeks. When he began to throw again two weeks ago on flat ground, he was encouraged. But once he started to throw off the mound, the soreness returned. Venters cut two mound sessions short last week in San Francisco.

His agent B.B. Abbott said Thursday’s operation brought a sense of relief.

“He is happy to have this done and feels one day closer to getting back to the big leagues,” Abbott said. “He just wanted to feel healthy again.”

Venters came up through the Braves’ minor league system as a starter, but made a name for himself in the majors as a reliever, throwing a mid-90s two-seam fastball from the left side.

He earned the nickname “Everyday Jonny” for seasons such as 2011, when he led the majors with 85 appearances. He made the National League All-Star team that summer while posting a 1.84 ERA with a .176 opponents’ batting average. He pitched in 230 games from 2010-12 and was one of the more dominant relievers in the majors.

The workload appeared to start catching up to him last season, when Venters had a 3.22 ERA in 66 appearances while dealing with intermittent elbow pain and a July stint on the disabled list.

His elbow started to bother him again in spring training, but an MRI on April 1 did not definitively show ligament damage. Andrews explained images can be unclear in the case of previous “Tommy John” patients.

Graham update: The Braves received good news Thursday on top pitching prospect J.R. Graham, who was diagnosed with a shoulder strain and prescribed a month-long plan for rehabilitation.

Graham was examined in Atlanta by the team’s lead orthopedist, Dr. Xavier Duralde. An MRI revealed what’s considered normal wear and tear for a pitcher.

“The prognosis was excellent that he’ll be back pitching in about a month,” Wren said.

Graham left his start Monday with Double-A Mississippi after two innings because of shoulder soreness.

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