Surgeon 'super happy' with Miley's hybrid elbow procedure

KANSAS CITY -- Even after repairing more than 3,000 elbows, many of them belonging to the most valuable arms in the world, Dr. Timothy Kremchek isn’t in the business of publicly discussing his work.

For Brewers pitcher Wade Miley, an exception was in order. Miley, 37, underwent a hybrid procedure on Tuesday to repair the elbow ligament damage that has bothered the left-hander for years before his 2024 season came to an abrupt end last month. He authorized Kremchek, who has been affiliated with the Cincinnati Reds for more than a quarter century, but has performed Tommy John surgeries for pitchers from all corners of Major League Baseball, to discuss his case with MLB.com.

“I’ve had a number of pitchers we have done this with in their mid-30s and they’ve done well,” Kremchek said. “They rehab, their elbow feels stable and they’ve come back and were able to pitch a few more years.

“Now, will he be able to? I don’t know. But at the start of the season, he looked good, and he was pitching on fumes. Without him having to worry about where his elbow is and how it feels, I’m very optimistic that this guy has a few more years in him. And so does he.

“I was pretty stoked. I was super happy when we were done.”

Kremchek is among a small group of experts performing a hybrid procedure in the past two-three years that offers patients -- including, in Kremchek’s case, former Brewers pitchers Brent Suter and Justin Wilson -- a more aggressive path to come back.

In Miley’s case, Kremchek said, the rest of the elbow was “pristine,” but the ligament was definitely in need of repair, and probably explains why Miley had been dealing with shoulder issues and other injuries recently as he compensated for the compromised elbow.

With the elbow fixed, Kremchek’s goal for Miley is to be throwing bullpens and facing hitters by Spring Training 2025, and ready to pitch for a team in late April or May of next year.

Miley re-signed with the Brewers in December for one year plus a mutual option for ‘25. The option is for $12 million with a $1.5 million buyout.

“He wants to go out on his own terms, and this is going to give him an opportunity to come back and throw,” Kremchek said. “With this new hybrid that we’re doing, you can really accelerate your throwing and your comeback.”

In a Tommy John procedure, the surgeon replaces the damaged ligament with a tendon from another part of the body. In the hybrid, a surgeon performs that step, then also places a collagen-braided brace that supports the elbow. It is a much more complicated procedure than a typical Tommy John surgery and means more stiffness in the joint in the short term, but more stability as well.

As a result, a player can begin strengthening his arm again without putting too much stress on the replacement ligament.

“It’s almost like a belt and suspenders,” Kremchek said.

The procedure took place on Tuesday morning in Cincinnati, with Miley’s family watching from the viewing room. It was Miley’s first surgery and he was visibly nervous -- not surprising for a pitcher who paces the hallways of clubhouses before his starts.

“He woke up happy as a lark,” Kremchek said. “He really wants to come back to Milwaukee and be with the team this year, and then work hard to give this thing a chance and pitch a few more years. I really think he can.”