So, I got curious about Bieber’s UCL surgery and did a little digging to see if he had an internal brace placed, went with autograft or chose allograft, and how his recovery has been.
Bieber had UCL graft surgery April 12, 2024. In his case it was an autograft: a tendon from his own body was harvested and used to replace the Ulnar Collateral Ligament. According to the internets, these are the common autograft sites for UCL surgery:
- Palmaris longus tendon: This tendon is located in the forearm and is a common choice because its removal doesn’t significantly impact hand function, according to Johns Hopkins Medicine.
- Hamstring tendon: The hamstring tendons, located at the back of the knee, are also a viable option.
- Toe extensor tendon: In some cases, a tendon from the big toe extensor can be used.
I suspect they’d use a tendon from his non-pitching arm. I wish he’d gone with allograft, frankly. That’s a cadaver tendon instead of one’s own. One does not need to incur an injury to fix an injury and one can choose much more robust arm than one’s own to graft from. The risk of rejection is minimal as is the disease risk. The recovery time, given the lack of concurrent other injury from harvesting, is nearly the same or even faster.
As an example, I had Anterior Cruciate Ligament replacement in my left knee at the same time as a (much younger & far fitter) colleague. I used allograft (donor Achilles tendon) and she opted for autograft (from the middle of her non-injured knee’s patellar tendon). My surgery left me with 4 small scars around my knee in spite of partial cartilage resection from a full thickness tear and bone fragment removal (yeah, don’t fall off of ladders, kids). Her surgery left her with two significantly scarred knees in spite of it being a much more straight forward procedure. She described her scars as “zippers” (apparently she’d been playing pickleball and injured her knee. Man. The youths these days. They’d all be a lot tougher if they spent more time outside drinking from the hose and not wearing seatbelts).
I was back to work by 3 months post op and 70-80% strength return by 4 months. Her recovery was almost double mine. Almost a year later and we can both now run around like our hair’s on fire and neither of us limp. I have an internal brace through my new ACL, so my bone doc has cleared me for all activities except swinging my driver off the tee for another 6 months post op (only 2 more months to go!). She’s also completely cleared for all activities but does run an increased risk of ACL damage to her other knee, which was where the graft came from. She does not have an internal brace, either.
Given that Bieber has already had one set back during recovery (June 3, 2025: soreness. Shut down for a week), and that he’s shown that his pitching form can shred a UCL, I wish he’d opted form the allograft in order to have a chance at a better pitching-foundational structure. The good thing is that if he shows signs of damage to his new UCL he can then have a brace procedure done with a much shorter recovery timeline.
All in all, he’s showing really well in AAA and will likely finish out the season in The Jays rotation. Given that in the end my younger and fitter colleague can once again out-race me to emergencies, I do believe the choice of graft won’t matter much for now.
As such, I’m ok with Rental Starting Pitcher, Shane Bieber.