From December 5th, 2003 ...
http://www.baseballprospectus.com/ar...articleid=2472
The trade of Eric Milton to the Philadelphia Phillies in return for Carlos Silva, Nick Punto, and a MLTBNLATRFD (minor leaguer to be named later, after the Rule 5 draft) is one fraught with medhead angst. Milton, of course, is coming off a season defined by and almost completely lost to an extensive knee surgery. Is this surgery the reason that the Twins were willing to move him, or was his 17-inning audition at the end of the 2003 season enough for the Phillies to be satisfied that he can move into a rotation that may lose ace Kevin Millwood?
Like most instances where baseball and medicine meet, the answer is "both." After Milton's late-March knee surgery, details came out about the severe deterioration that was found despite his relatively youthful age of 27 (he's now 28). His surgeon, Dr. Thomas Rosenberg had operated earlier in 2003 on Tiger Woods, but unlike Woods' relatively simple surgery, Rosenberg found Milton's knee required much more extensive work. In the procedure, Rosenberg removed more than 30 discreet pieces of cartilage from both the medial and lateral meniscus. He was also forced to debride what was described as significant osteoarthritis from the knee both above and below the joint. As you can see from this illustration and description of similar procedures, Milton's knee likely looked like that of a much older person that may at some point be a candidate for complete joint replacement in order to maintain function.
The six-month recovery and involved rehabilitation that Milton went through in order to return to the game went according to plan, according to Twins sources. Once he began to pitch again, both in drill and during a brief minor league rehab stint, it was clear that at least in the short term, Milton was able to return to his previous level of pitching. There is, however, a significant worry that his knee will continue to degrade over the course of a full season, endangering his ability to contribute as expected. It's one thing to pitch 17 good innings and quite another to the reach the 200-inning level for which the Phillies are paying.
Milton's injury is similar to, but much more advanced than that of fellow lefty Randy Johnson. Johnson was able to come back after injections of synvisc, a synthetic lubricant that seeks to reduce bone-on-bone friction in the absence of normal, natural shock absorbers. There is a great deal of disagreement over which, if any, technique is more effective in the long-term, but sports medicine often takes an odd perspective on both efficacy and function. There is clearly room for interpretation and individuality. Where both techniques returned the respective pitchers to function, both are also likely to be walking around with their children and grandchildren on a replacement joint. It is one price of professional sports that we seldom see.
The Phillies receive a pitcher with significant risk of recurrence who will likely pitch--and walk--with some level of pain. It is Milton's pain tolerance and the abilities of the Phillies' medical staff that will decide his effectiveness on the mound. The team takes on a one-year risk, which given the usual timeframe for recurrence, is only slightly elevated over a normal pitcher of this age. They also deal with a known quantity: By knowing the level of damage, the Phillies' staff will be able to come up with a plan to keep Milton as healthy as possible, something they were unable to do in Minnesota before the problem showed up.
