Carlos Carrasco will be lost for 12 to 18 months, but second baseman Jason Kipnis was activated Tuesday and Travis Hafner could be close behind.
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Chuck Crow, The Plain DealerCarlos Carrasco, shown celebrating a strikeout in a June victory over Pittsburgh, needs Tommy John surgery on his right elbow.
CLEVELAND, Ohio -- Carlos Carrasco, who at times this season seemed to be emerging as a front-line starter, will undergo Tommy John surgery on his right elbow on Sept. 14 and be lost to the Indians for 12 to 18 months.
Dr. David Alchek, who recently examined Carrasco, will perform the surgery in New York. Alchek works for the New York Mets.
"This is a big blow to our rotation," said manager Manny Acta.
Carrasco (8-9, 4.62) was on the disabled list twice this year with elbow pain. Head trainer Lonnie Soloff said the injury is probably the result of an injury Carrasco suffered as a teenager in Venezuela.
"Carlos told us he hurt his elbow when he was 14 and didn't throw for six to eight weeks," said Soloff. "That was evidenced by the chronic, or old, changes on the MRI. Then just through repetitive throwing over the years, the ligament is not doing the job it should be doing -- stabilizing the inside of the elbow."
The Indians acquired Carrasco, Lou Marson, Jason Donald and Jason Knapp from Philadelphia for Cliff Lee and Ben Francisco on July 29, 2009. Marson and Donald are the only ones still healthy. Knapp had shoulder surgery almost immediately after the deal. He underwent a second shoulder surgery earlier this year and the Indians are hopeful he'll be ready for spring training in 2012.
It usually takes between 12 months to 18 months for a pitcher to recover from ligament transplant surgery on his elbow. The operation is named after John, a one-time Indians pitcher, because he was the first to have it.
Carrasco made his last start on Aug. 3 against Boston. Shortly after that he experienced elbow inflammation during a bullpen session and was placed on the disabled list. The Indians treated the injury conservatively, but Carrasco did not respond.
The Indians sought advice from several doctors on how to treat Carrasco's elbow. Some suggested an arthroscopic procedure, which would have had a shorter recovery time.
"That would have probably been sufficient for a short period of time," said Soloff, "but it was in his best interest, as a 24-year-old pitcher, to move forward with UCL reconstruction (Tommy John surgery)."
Carrasco went on the disabled list for the first time after a start against the Twins on April 24. Soloff said that was the first time Carrasco had a MRI on his elbow as a professional. The Indians or Phillies didn't give Carrasco an MRI because he never had an arm problem.
"Different organizations have different philosophies," said Soloff. "Lots of times, when athletes injure a ligament, it's one acute injury. They feel a pop or pain. But in the lion's share of cases, it's just the gradual lengthening of the ligament to where it's not doing its job."
Injuries R Us: DH Travis Hafner (strained right foot) is making progress toward returning to the lineup before the end of the season.
"He's progressed to full batting practice," said Soloff. "He's begun a running program on the anti-gravity treadmill and will start running on the ground Wednesday. Then we'll gradually increase that."
There is a still a chance Hafner will need surgery after the season. Soloff said that's why it's important that the Indians get a read on him in game conditions before the end of the season.
"If he continues to have symptoms, if he feels there's a functional deficit in his ability to hit and run, that would be an indication to address his foot surgically," said Soloff. "If he goes through his rehab and does well, then we'd have a decision on what is the best approach."
Soloff said if Hafner does have surgery, the ligament in question would be realigned to ease the discomfort in the foot.
Yeah, he's back: Rookie Jason Kipnis returned to the lineup Tuesday night at second base for Tuesday's game. He's recovering for a strained right oblique and hamstring injury.
"We're not going to run him out there every day," said Acta. "He'll be doing his rehab here, much like Grady Sizemore."
Kipnis sounded like he'd been tipped off a couple of days in advance about when he'd be able to play again. He's been on the disabled list Aug. 19, a move that was retroactive to Aug. 13.
"This is like another debut for me because it's been a while," said Kipnis. "I'll see how quickly I can get the rust off."
Finally: Luis Valbuena was recalled from Class AAA Columbus.
Tonight's lineups:
Tigers lineup (79-62): CF Austin Jackson (R), RF Andy Dirks (L), LF Delmon Young (L), 1B Miguel Cabrera (R), DH Victor Martinez (S), C Alex Avila (L), SS Jhonny Peralta (R), 3B Don Kelly (L), 2B Ramon Santiago (S), RHP Rick Porcello (12-8, 5.01).
Indians (70-68): CF Grady Sizemore (L), RF Kosuke Fukudome (L), SS Asdrubal Cabrera (S), 1B Miguel Santana (S), DH Jim Thome (L), 2B Jason Kipnis (L), 3B Lonnie Chisenhall (L), LF Ezequiel Carrera, C Lou Marson and RHP Fausto Carmona (6-13, 4.84).
Umpires: H Larry Vanover, 1B Brian Gorman, 2B Tony Randazzo, 3B Jim Wolf.
Lefty vs. righty: Lefties are hitting .284 (99-for-348) with 10 homers and righties are hitting .243 (71-for-292) with 10 homers against Carmona. The Tigers have five lefties, including two switch-hitters, in the lineup.
Lefties are hitting .337 (120-for-356) with 13 homers and righties are hitting .242 (58-for-240) with three homers against Porcello. The Indians have eight lefties, including two switch-hitters, in the lineup.
Next: Two of the best starting pitcher in the AL face each other Wednesday when Justin Masterson meets 21-game winner Justin Verlander. STO/WTAM will carry the game.