Injury Profile: Ben Roethlisberger


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Injury Profile: Ben Roethlisberger

Too Long/Didn’t Read

  1. Big Ben ruptured his ulnar collateral ligament on his throwing arm and had a procedure to fix it.
  2. It’s unknown which specific procedure he had, but it was either a Tommy John or primary repair. The primary repair has a faster recovery but is a riskier procedure due to the lack of evidence surrounding it.
  3. From the sounds of it, Roethlisberger should be back by Week One and can be serviceable in 2020, but comes with inherent risk as a 38-year-old coming off of a major surgical procedure.


There seems to be quite a bit of confusion about the surgery Ben Roethlisberger had in 2019. The preponderance of evidence indicates that he ruptured the ulnar collateral ligament of his throwing elbow in September of 2019; however, conflicting reports here, here, and here have led to confusion about the specific procedure he had to fix it. More specifically, the question is whether he had the traditional Tommy John surgery (replaces old ligament completely) or a primary repair (sutures together the older ligament). Nonetheless, the specific injury, subsequent surgery, and his current rehab are serious, so deciphering which procedure he had is, for the most part, a fruitless exercise. Instead, I’ll discuss the range of outcomes.

What it Means

The primary difference between the procedures is the return to competitive throwing time is longer for those who have the Tommy John procedure compared to the primary repair. Generally, baseball pitchers return to pitching around 10-12 months but can take up to 18 months. Pitchers who have had a primary repair return around 9-12 months. The conflict in deciding between the two surgeries is that the evidence for Tommy John is robust to say the least. It’s well-established that pitchers who undergo Tommy John procedure can improve their ERA, allow fewer walks, and give up fewer hits per inning once they recover. Conversely, the primary repair, although promising, is comparatively in its infancy as it relates to successful outcomes and improved performance. The chances of the primary repair “failing” even partially are simply unknown and have been documented. So why choose the primary over the T.J.?

It’s faster.

Given all of that information, it’s intriguing that Big Ben didn’t start throwing until February (five months after surgery) considering most pitchers start light throwing around three months after a primary repair. But again, trying to decipher the specifics is a fool’s errand and the bottom line is that in March he was throwing 20 feet every other day and said he wanted to be “80-90% by OTA’s and mini-camp,” which means he obviously expected to be back and 100% by Week One. At that time, he’ll be almost a full year removed from the surgery and should, in theory, be ready to roll. However, my previous full-blown confidence that he’ll come back better than ever is in jeopardy if he didn’t have the Tommy John procedure. The clarity is even further muddled when we consider that all of this evidence and data is on baseball pitchers and not NFL quarterbacks. Although the physical demands of two positions are similar, the biomechanics are vastly different making the recovery vastly different.


In September of 2019, Big Ben either had Tommy John surgery or a primary repair of the elbow ligament on his throwing arm. Those procedures are similar in that they both take at least 9-10 months to heal completely, but the primary repair has a slightly faster recovery. The flip side is that the primary repair does not have the same credibility or tried-and-true improved performance outcomes like the Tommy John does. In the end, there’s now a shade of durability doubt cast over not only Roethlisberger’s elbow, but also on his overall age and conditioning. He’ll likely perform in 2020 but the likelihood of his 38-year-old body continuing to break down is in the realm of possibilities.

Edwin completed his Doctorate of Physical Therapy education in 2020. His expertise is in all thing’s orthopedics, injury recovery, and he has a special interest in human performance. Edwin’s vision is to push injury advice past simple video analysis and into the realm of applying data from the medical literature to help fantasy players make informed start-sit decisions.