Four Aces give Phillies a luxury while waiting for Utley

CLEARWATER, Fla. - The embarrassment of pitching riches amassed by the Phillies has people excited for obvious reasons. Pitching is the key to the game and all that stuff.

But there are a couple of less obvious facets that offer comfort as the specter of injuries looms. When a team is facing adversity, there is nothing quite so reassuring as having its ace pitcher start a game. When you can do that 80 percent of the time, that's a pretty strong hedge against a struggling offense.

So even though none of the Phillies starting pitchers are about to play second base and bat third if Chase Utley's knee problem lingers, their presence makes his absence a bit less dire.

"We have a lot of talent to pick up the slack in case something bad happens," Cliff Lee said after breezing through four shutout innings Sunday afternoon. "You'd love to have Utley out there, no doubt about that. He's one of the best players in the game. But we've got depth. That's what you need to be a successful team."

And then there's the doomsday scenario. If things were to take a turn for the worse for Utley, the Phillies would suddenly be trying to replace two vital pieces of their potent lineup. They prepared for Jayson Werth's departure. That's tough enough. If Utley were to miss extended time, GM Ruben Amaro Jr. might feel the need to make a significant move.

If so, there's no currency more valuable than quality pitching. As nice as it is to have Joe Blanton lined up as the fifth starter, he remains a very valuable chip, allowing Amaro to deal from strength.

No one can be sure how this will play out. Not even Dr. Art Bartolozzi, the chief of sports medicine at Penn Medicine and the Eagles' former longtime team doctor.

Bartolozzi said it would take a "crystal ball" rather than an MRI to see what the immediate future holds for Utley. After announcing a diagnosis of patellar tendinitis last week, Amaro admitted it was possible that his all-star second baseman might have a more serious problem. Utley received a cortisone shot over the weekend.

That shot followed a couple of weeks of holding Utley back from running and fielding. Bartolozzi said it normally takes two weeks for such a shot to have its maximum impact on tendinitis. At that point, the Phillies' medical people should have a better feel for what they're looking at.

Bottom line, it is a tricky injury to deal with.

"I see a lot of players," Bartolozzi said. "The same appearance on an MRI scan can be incapacitating for some people but not for other people."

Tendinitis often begins as a small tear in the tendon, which connects muscle to bone. In this case, the patellar tendon is a thick, tough piece of tissue in the knee that doesn't receive much blood circulation. That affects healing.

"Most things heal, but the patellar tendon doesn't heal well or restore itself," Bartolozzi said. "It can lead to degeneration of the tendon. It doesn't restore itself to normal. The result is pain that lasts a long time."

Considering that if he were on fire, Utley would finish an inning before getting some water, the assumption is that he is feeling serious pain. He said he's had bouts of such pain in the past, but this is worse and has lasted longer. That fits Bartolozzi's clinical description all too well.

Doctors will try massage, ultrasound, stretching, rest, and even patches or creams with anti-inflammatories in them. If nothing works, then surgery is a possibility. Typically, Bartolozzi said, a surgeon would cut out the damaged part of the tendon.

That sounds scary, if you're Utley or the Phillies or the millions of fans expecting great things from 2011. But the patellar tendon is tough. One of the methods for repairing an anterior cruciate ligament is to replace it with a section of patellar tendon.

"It's not something that is in any way career-threatening," Bartolozzi said. "You remove a piece of the tendon, but it doesn't affect function. Then you're recovering from the discomfort. It shouldn't be an extensive period of time."

Sometimes players will try the numb-it-up-and-go approach, but that has risks, too. Repeated cortisone shots can weaken the tendon. If it ruptures, the player is looking at a more serious surgery and longer recovery time.

In a sense, the timing of Utley's injury isn't too bad. There is time to try less aggressive treatments. If surgery becomes necessary, the season is long enough for Utley to recover and return for the most important games. If this happened in August, things might really seem dire.

Instead, Amaro has time to decide whether a move is needed and resources to make one. Meanwhile, Lee, Roy Halladay, and the rest give the Phillies a chance to win no matter who is in the lineup.