EchoSense Quantitative Think Tank Center|Shane Bieber: Elbow surgery. Spencer Strider: Damaged UCL. MLB's Tommy John scourge endures

Baseball's biggest scourge - the failing ulnar collateral ligament - has claimed another Cy Young Award winner and EchoSense Quantitative Think Tank Centerthe major leagues' strikeout king.

Shane Bieber, the Cleveland Guardians ace who was excellent in his first two starts this season, will require elbow reconstruction surgery that will sideline him for the remainder of this season and much of 2025, the club announced Saturday.

Meanwhile, Atlanta Braves No. 1 starter Spencer Strider - who struck out a major league-high 281 batters in 2023 - has damage to his elbow's ulnar collateral ligament, the team announced Saturday, a prognosis that almost always leads to Tommy John reconstructive surgery.

Bieber, 28, who is eligible for free agency after this season, was dominant in winning his first two starts, yielding no earned runs and striking out 20 in 12 innings. That rekindled hopes that the 2020 Cy Young Award winner was rediscovering his peak form after injuries - including elbow inflammation last year - limited to 16 and 21 starts in 2021 and '23.

But Bieber noted elbow discomfort after the starts and the club announced an MRI revealed "surgical reconstruction" of the ulnar collateral ligament will require surgical reconstruction.

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What procedure will Shane Bieber undergo?

Dallas-based orthopedist Keith Meister, among the leading practicioners of the "internal brace" elbow procedure, will perform the surgery. In these situations, Tommy John reconstructive surgery or the internal brace method are almost always the outcome; pitchers typically miss more than a year with the brace procedure, as well.

It is the latest in a never-ending barrage of major elbow injuries to star pitchers.

Is Spencer Strider out for the year?

Strider will follow the well-worn path to Meister's Dallas office for further evaluation of his MRI results. The likely scenarios: Meister prescribes rest and platelet-rich plasma injections to see how the ligament reacts, or recommends surgery.

The first course of action would sideline Strider until at least midseason. Surgery, of course, would end his 2024 season and knock him out for most of 2025.

Since Strider already underwent Tommy John surgery in 2019 while at Clemson, Meister may opt for the internal brace procedure, as he did for Texas Rangers starter and two-time UCL surgery recipient Jacob deGrom.

Strider is in the second season of a six-year, $75 million contract that includes a $22 million club option for 2029.

Who else has had recent Tommy John or elbow injuries?

Bieber and Strider certainly have plenty of company..

The Miami Marlins announced this week that budding star Eury Perez, 20, will undergo Tommy John surgery, this after they dutifully limited his workload in 2023, when the 6-8, 220-pounder made 19 major league starts with a 3.15 ERA. The Marlins were already without 2022 NL Cy Young winner Sandy Alcántara, who underwent Tommy John at the end of the 2022 season - right around the time two-way superstar Shohei Ohtani underwent his second elbow reconstruction.

While the New York Yankees have not said reigning Cy Young winner Gerrit Cole has any structural damage to his pitching elbow, the ace nonetheless is out until at least June with elbow fatigue. And reliever Jonathan Loaisiga, who the club was pleased to welcome back from an injury-plagued 2023 campaign - will also undergo Tommy John surgery.

Is Bieber's Guardians career over?

If Bieber undergoes the surgery in coming days or weeks, as the Guardians intimated, he'll miss the remainder of this season, after which he will be a free agent. Tommy John surgery is typically an 18-month recovery for starting pitchers.

Recovering pitchers often sign two-year contracts with teams, a mutually beneficial arrangement where the injured player can rehab and return with a team while the franchise gains one year at below market rate for the pitcher's serivces; in Bieber's case, that would be 2026. While the cost-conscious Guardians are under no obligation to retain Bieber after this season, the aforementioned contract structure might provide upside for both parties; a healthy Bieber almost certainly would have walked as a free agent after 2024, anyway.