Los Angeles Angels two-way star Shohei Ohtani had elbow surgery on Sept 19

The future of Los Angeles Angels two-way star Shohei Ohtani could not be murkier.

After another outstanding season in which Ohtani led the American League with 44 home runs, the Japanese star will become a free agent after the World Series as he prepares to be offered an unprecedented contract.

From left: General manager Perry Minasian, Shohei Ohtani and manager Phil Nevin of the Los Angeles Angels appear at Angel Stadium of Anaheim in Anaheim, California, on Saturday. (Ronald Martinez/Getty Images)

Ohtani is a marvel, dominating both on the mound and at the plate as a modern-day Babe Ruth. His two-way talent makes his value hard to calculate, and his recent surgery makes it even more difficult.

Ohtani underwent surgery on his right elbow — the second of his career — on Sept. 19 after tearing his ulnar collateral ligament on Aug. 23.

In an announcement from Ohtani’s agent, Dr. Neal ElAttrache provided information on the surgery without saying that Ohtani underwent a second Tommy John procedure.

“The ultimate plan after deliberation with Shohei was to repair the issue at hand and to reinforce the healthy ligament in place while adding viable tissue for the longevity of the elbow,” ElAttrache said. “I expect full recovery, and he’ll be ready to hit without any restrictions come Opening Day of 2024 and do both (hit and pitch) come 2025.”

ElAttrache also performed the Tommy John surgery on Ohtani on Oct. 1, 2018, according to The Associated Press.

Dr. Christopher Ahmad, chief of sports medicine at NewYork-Presbyterian/Columbia University Irving Medical Center, spoke with Fox News Digital about a tear in the UCL, the surgery options and the impact a second elbow surgery can have on the rehab process.

Los Angeles Angels pitcher Shohei Ohtani throws against the Detroit Tigers during the first game of a doubleheader at Comerica Park in Detroit on July 27, 2023. (AP Photo/Paul Sancya)

“Without knowing the circumstances of the surgery, a very typical situation, if it’s not a revision, is you hear that the ligament was reconstructed, that’s Tommy John surgery,” Ahmad told Fox News Digital. “Another situation that’s typical is when the native ligament is repaired but not reconstructed. A new tissue didn’t get put in. It’s repaired and you get an internal brace. That’s a very common operation.

“When I hear in the setting of a revision that it was repaired, but new tissue was put in, it’s confusing what that new tissue is. Is that new tissue a graft that was used to help reinforce some of the injured ligament? And there’s this issue of internal brace, which is a very common way to manage a revision, a second-time surgery. If the graft got injured from the original Tommy John surgery, you can repair that torn graft, and then you can protect it with the internal brace. A nice description of the internal brace is a device that acts like a seatbelt, and if you have a seatbelt in place, you have protection, and that allows you to have a faster recovery along with the healing tissue.”

A second elbow injury for an athlete, while not uncommon, means there are a few options as far as the type of procedure the athlete can undergo.

“If you have a reconstruction, it’s possible that you can reinjure that ligament again. And if it’s reinjured — that ligament again — the choice of treatment depends on how the ligament injury characteristics are,” Ahmad said.

Los Angeles Angels pitcher Shohei Ohtani throws against the Seattle Mariners during the game at Angel Stadium in Anaheim, California, on Aug. 3, 2023. (John Cordes/Icon Sportswire via Getty Images)

“If it’s a focal area of the injury to the prior surgical reconstruction, that often can be repaired. And by repair, we mean we sew it back together, stitch it back together. Then we put the internal brace device on and that can allow patients to get back to playing at very high levels.

“If the reconstructed tissue that got injured again is too badly damaged, it’s blown up — like it’s shredded, to exaggerate — then there’s no way to sew it back with reliable healing. And, in that situation, a second Tommy John surgery, which we call revision reconstruction, is more predictable for success.”

The question now becomes whether a second surgery on the same elbow will have an impact on Ohtani’s recovery time as he prepares to enter free agency.

“Often a second-time surgery does not mandatorily mean a delayed or decelerated rehab process, but there may be some reasons why the rehab process would be a little bit modified and what we would call a little more cautious,” Ahmad told Fox News Digital. “And that is, if it’s a second-time surgery, there’s a very strong emphasis on avoiding any potential problems. And those problems could happen during the rehab process.

“For example, if the player during the rehab process is having some stiffness in their back. They’re just having some back stiffness. If it’s a first-time surgery, you might say, ‘We can work through that back stiffness.’ But if it’s a second-time surgery, we may delay the rehab until the back stiffness is resolved because we don’t want any negative impacts on the rehab process because we can’t afford to have a compromise to a second-time surgery. A third-time surgery can be extremely devastating. So, we go a little slower.”

Shohei Ohtani of the Los Angeles Angels sits on the bench during the game against the Detroit Tigers at Angel Stadium of Anaheim in Anaheim, California, on Sept. 16, 2023. (John McCoy/Getty Images)

The two elbow procedures offer different timelines for recovery. Ahmad told Fox News Digital that an athlete can begin their throwing program in three to four months, while a return to the mound can be as early as 10 months with a repair operation. The recovery for a revision reconstruction is slightly longer, with the throwing program potentially being initiated between four and a half to five months and a return to the mound in a timeframe closer to 14 months.

Ohtani was expected to demand a record-breaking contract before suffering the torn UCL, and it is unclear what impact, if any, the second elbow surgery will have on his free agency now that it is known the 2021 AL MVP will not pitch until 2025.

The Angels face a great deal of uncertainty as they head into the offseason.

For the ninth consecutive season, the Angels will not be involved in postseason play after going 73-89 and finishing 17 games out of the final wild card spot in the American League.

On Monday, the team declined the option on manager Phil Nevin’s contract and will begin the search for their fourth manager in six seasons.