Surgery likely for Johan Santana

Two-time Cy Young Award winner Johan Santana has suffered a probable re-tear of the anterior capsule in his left shoulder and a repeat surgery is a "strong possibility," New York Mets general manager Sandy Alderson said Thursday.

Santana needed 19 months to throw a major league pitch after the first procedure, which had been performed on fewer than a dozen pitchers in major league history.

Now, he likely would need to overcome the surgery twice, this time at age 34, in order to return to pitching.

Santana is in the final guaranteed season of a six-year, $137.5 million deal with the club. There is $31 million still owed on the contract, all of which is not insured.

Santana was examined in New York on Wednesday by team doctor David Altchek, who performed the original Sept. 2, 2010, procedure. An MRI revealed a probable re-tear. At the request of Santana's agent, Altchek consulted with renowned doctors James Andrews and Lewis Yocum. Both confirmed the probable diagnosis of the re-tear of the anterior capsule, Alderson said.

Santana will remain in New York this weekend to deliberate before committing to surgery.

"If this diagnosis proves to be correct, I think in all likelihood Johan will be lost to the Mets for the season," Alderson said.

Alderson said it's unclear when the reinjury occurred. Santana twice during spring training had been backed off mound work because of what was labeled shoulder weakness.

Santana had a strong first half of last season after returning from the surgery, highlighted by tossing the first no-hitter in franchise history, on June 1 against the St. Louis Cardinals.

Manager Terry Collins agonized in allowing Santana to throw a career-high 134 pitches in the no-hitter but deemed the historical moment worthwhile for the southpaw to try to complete.

It was straight downhill for Santana, however, after that performance. He had an 8.27 ERA over the next 10 starts before landing on the disabled list to finish the season.

The Mets had attributed the swoon and shortened 2012 season to multiple factors: arduous rehab work the previous winter that left him worn down, an ankle injury caused when Reed Johnson stepped on Santana's ankle during a bang-bang play while the southpaw covered first base, and a lower-back injury.

The surgery to repair a torn anterior capsule had been performed previously on only a handful of pitchers, beginning with Bret Saberhagen on May 28, 1996, Altchek told ESPNNewYork.com last year. The surgery on Santana left a two-inch scar at the front of his prized shoulder.

The sparse list of pitchers now also includes Chris Young, Mark Prior, Chien-Ming Wang, Rich Harden and Dallas Braden.

Because anterior capsule surgery has been performed so infrequently on pitchers, how Santana's recovery unfolds will contribute to determining the procedure's effectiveness in extending careers, Altchek had added.

The capsule is the set of ligaments that run between the ball and socket, holding them in place. The ligaments nearly completely encircle the shoulder. They span the front, bottom and back of the shoulder, but not the top.

Tearing the anterior capsule can result in the ball slipping forward in the shoulder socket during the delivery. Young actually felt discomfort in the back of his right shoulder before his May 16, 2011, surgery -- even though the tear was in the front of the capsule -- because the rear ligaments that remained intact were stretching as the ball slipped forward in his socket.

If the tear occurs on the socket side, the repair can be done through a less invasive arthroscopic procedure, as was the case with Braden, as well as former New York Yankees catcher Jorge Posada. If the tear is on the ball side, the surgeon is required to make an incision and go in through the front. That was the case with both Santana and Young.

Torn anterior capsules very likely are not new injuries among pitchers. Standard MRIs often are not conducive to revealing the tears. A more sophisticated MRI usually is required, or some other sleuth work.