Tarik Skubal is back on the mound. His agent, Scott Boras, already has a name for what got him there so fast.
"The Skubal scope," Boras called it after Skubal became the first known MLB player to undergo a procedure using the NanoNeedle Scope 2.0. The minimally invasive device is the size of a toothpick and it helped remove a loose body from the two-time Cy Young Award winner’s left elbow.
Skubal, who is scheduled to start Saturday, needed just 12 days to get back on the mound for a full bullpen and just 32 days from surgery to his rehab start on June 7. The new technology knocked weeks off a surgery and rehab that normally takes more than two to three months.
It marked the beginning of a new way to treat one of baseball’s most stubborn and frustrating pitching injuries.
Scenes from Detroit Tigers pitcher Tarik Skubal's rehab start with the West Michigan Whitecaps on June 7 in Comstock Park, Mich.
"Any time you can get in and out without leaving much of a trace at all, it’s a huge benefit," said Dr. Neal ElAttrache, the orthopedic surgeon behind some of the biggest procedures in professional sports.
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ElAttrache, the team doctor for the Los Angeles Dodgers and NFL's Los Angeles Rams, had been waiting for the right case to try the NanoNeedle. Skubal, dealing with a single loose body and having the motivation of being in his final year of a contract, was it.
The timing mattered as much as the technology. A pitcher who stops throwing in April or May doesn’t just pick up where he left off. He must reset back to spring training to ramp up. For Skubal, who is set to become one of the most coveted free agents on the market this offseason, every missed start carried extra weight.
"The nature of the procedure is one thing," ElAttrache said, "but the timing is the other."
Launched just last September, the NanoNeedle Scope 2.0 is made by Arthrex, a Florida-based medical device company. Traditional elbow surgery requires a scalpel to cut through the skin and tissue before a surgeon can even get inside the joint. The NanoNeedle punctures through like a needle, causing far less damage going in. Surgeons still need to pump fluid into the joint to inflate it so the camera can see what it’s working on. The NanoNeedle needs a fraction of what a traditional scope needs.
The less fluid pumped in, the less the joint swells, it lowers the pain and a pitcher is ready to throw quicker.
Ryan Keller, Arthrex’s senior product manager, said the NanoNeedle uses roughly one-seventh the fluid of traditional arthroscope. Keller said studies show patients who undergo the procedure rarely need so much as a Tylenol afterward.
Skubal wore a battery-powered patch called Jumpstart over the wound site, another Arthrex device. It sends a small electrical charge through the skin to kill bacteria and speed healing.
Before the procedure, Skubal had been pitching with a loose body that was starting to lock his elbow mid-delivery.
"You can imagine how disconcerting that is," ElAttrache said, “to have in the back of your mind, as a random warning that your elbow is going to lock in the middle of throwing 99 miles an hour."
Scenes from Detroit Tigers pitcher Tarik Skubal's rehab start with the West Michigan Whitecaps on June 7 in Comstock Park, Mich.
A pitcher managing that can’t fully convince himself the problem is gone until he is throwing free and easy again. One the surgery was done and the swelling stayed down, Skubal didn’t have to spend his first bullpen session wondering if he was going to feel it again.
"You can’t get rid of the apprehension if your elbow is still sore," ElAttrache said. "He was able to get rid of that apprehension within his first bullpen throwing session."
Dodgers left-hander Blake Snell had the same procedure, but his case was more involved. ElAttrache said the recovery won’t match Skubal’s pace, but he expects it to cut Snell’s time off roughly in half.
He won’t be the last pitcher that benefits from it. Loose bodies keep coming. Already this season Cincinnati Reds ace Hunter Greene and the Dodgers' Edwin Diaz have had them. It has become one of baseball’s most persistent and least glamorous injuries.
And until now, one of its most disruptive.
The NanoNeedle won’t fix everything, but it can be used for other injuries.
ElAttrache said it won’t replace Tommy John surgery, but since it can go where other traditional tools can’t, it can help with shoulder injuries, meniscus tears and with spots that do not show up clearly on MRIs. A surgeon can now look directly at those areas with something the size of a needle and barely leave a mark.
And it’s advancing. The NanoNeedle Scope 3.0 is coming before the end of the year. Keller said it will have better image quality. Eventually he thinks it could replace traditional arthroscopy entirely.
ElAttrache’s mentor was Frank Jobe, the surgeon who invented Tommy John surgery.
Arthrex is getting publicity because of Skubal and Winnipeg Jets goalie Connor Hellebuyck, who had surgery with the NanoNeedle before the 2024 Paris Olympics. But they also are also pushing into cardiovascular, obstetric and pediatric medicine.
So, a tool that will help save a pitcher’s contract year might end up changing how traumatic orthopedic surgery is for kids in the future.
ElAttrache has seen it before and it’s part of what drives him.
"The things you develop to help these famous athlete end up helping the masses," ElAttrache said. "Especially for kids. I see this as something that will be very useful to help kids."
