Preseason injury watch: 1B/DH

The 2013 fantasy baseball season is right around the corner. Aside from tracking which players have traded uniforms and ballparks, gauging the health of those with injury concerns is of paramount importance. Each position has a few key fantasy players -- we've addressed only those players in the Top 150 for now -- with question marks by their names entering the spring. While teams limit the details of players' medical histories, there is still significant information to be gleaned from an understanding of the athlete's condition and status report updates as to his activity. As the regular season approaches, these situations will evolve, since many players recovering from injury or surgery will progress their activity accordingly or, in some cases, will encounter delays or setbacks.

Corey Hart, Milwaukee Brewers: Hart underwent surgery on his right knee in late January after it continued to swell and cause discomfort in the offseason. The procedure was described as a debridement (cleanup), but his prescribed non-weight-bearing status for six weeks hinted at a chondral (cartilage) defect which required attention. The postoperative course of no weight through the extremity following such a procedure is designed to be protective. A damaged area of bone is stimulated during surgery to bleed a small amount, allowing healing factors to enter the area. A miniclot is formed in response to the bleeding and ultimately morphs into a cartilage layer which protects the previously exposed bone. While it is not identical to the original cartilage surface, the "replacement" layer does offer protection for the bone.

Due to the delicate nature of the healing joint surface, activity following such a procedure is very controlled. Even after weight-bearing is introduced, any increase in activity is measured. In Hart's case, he won't begin to bear weight until early March. He is then expected to need another six to eight weeks to return to play, presuming no setbacks. Hart recently told reporters that he believes he can be ready as early as the end of April, but that seems optimistic. After the extended downtime, not to mention the fact that his knee was ailing for some time before surgery, it would not be surprising if it takes Hart longer to return to full strength. If his teammate Mat Gamel (coming off ACL reconstruction himself) is able to hold down the first base fort, it seems unlikely the Brewers would allow Hart to rush his return. Given the uncertainty of how he will respond to activity, it might be best to anticipate roughly a two-month absence for Hart, perhaps longer if the need arises.

March 17 update: With Gamel out for 2013 after re-tearing his ACL, Hart's status becomes even more critical for the Brewers. Fortunately, the Brewers have gotten some good news regarding Hart of late. According to the Milwaukee Journal-Sentinel, an MRI taken the first week of March showed good healing in the knee, and Hart is now allowed to bear weight on it. That said, he still has a ways to go in terms of rehab progression, and the Brewers are not expecting him to be ready until late May, despite his assertions that he will return sooner. He will open the season on the DL, and the Brewers will have to plug a hole for at least a few weeks.

Mat Gamel, Milwaukee Brewers: Gamel tore his right ACL while chasing a foul ball in early May (that will teach him not to hustle) and subsequently underwent reconstructive surgery. Now nine months removed from the procedure, Gamel has had ample time for rehab and is poised to re-sharpen his return-to-play skills during spring training. With teammate Corey Hart expected to miss time at the start of the season, Gamel is expected to own the starting role for at least the first month.

March 17 update: Gamel won't be replacing Hart to start the season after all; he tore his ACL again. What an unfortunate turn of events for the first baseman who is now looking at a 2014 return after undergoing his second ACL reconstruction on his right knee. It also serves as a reminder that even though ACL surgeries and the associated recovery have become more commonplace, nothing can be taken for granted.

David Ortiz, Boston Red Sox:
At 37 years of age, Ortiz is not expected to be quick around the bases; the hope is that he can make the tour without limping or risking a season-ending injury. After suffering an injury in mid-July while baserunning, Ortiz's 2012 season came to an early close due to persistent pain in his Achilles. He underwent a platelet-rich plasma (PRP) injection in late August, but he was never able to return to the playing field. Subsequent treatment and training in the offseason has Ortiz convinced he will be ready by Opening Day, but his activity is still restricted as he eases back into action.

The injury was to his right (lead-hitting) leg, which means less stress is placed upon it as he exits the batter's box. Still, the physiologic demands of running will place a heavy load on the tendon, and the unknown is just how well the tissue has repaired itself, even if Ortiz has overcome the pain. He certainly appears to be improved from where he left off in 2012, but there's a reason the contract extension Ortiz signed in November has incentives tied to the health of his Achilles. No one can be certain that the tendon issue is completely in the rearview mirror.

March 17 update: Persistent pain has been a problem for Ortiz this spring, and ultimately the difficulty he continued to experience with baserunning resulted in an MRI of both heels. According to the team, the MRI showed inflammation in both heels and Ortiz was shut down for several days. Both Ortiz and the Red Sox seem to be preparing everyone for the likelihood that Ortiz will begin the season on the DL. He has not been able to resume BP since suffering the setback.

Lance Berkman, Texas Rangers: Berkman didn't do much in 2012; the combination of calf and knee injuries he suffered caused him to miss more than 75 percent of the season. His hope, along with that of his new team (which signed him to a one-year deal), is that the combination of last year's procedures and this year's primary role as a DH will yield better results with lower risk. Berkman's knees can hardly be called healthy, considering the wear and tear they have already endured.
He originally tore his right ACL and underwent reconstructive surgery in 2004. In 2010, he underwent surgery to remove loose bodies and address cartilage damage in his left knee. Last season, Berkman's right knee was again the source of trouble (originally he feared he had re-torn his ACL), and he had surgery to address a meniscus tear in May. Four months later, he was back in the operating room for another procedure, and retirement seemed possible. His role with the Rangers is expected to be primarily as a DH, but he still needs to be able to run the bases. Berkman should start the season on time, but the bigger question will be whether his legs will hold up for another season.