Rubby De La Rosa had already undergone Tommy John surgery. So when his right elbow became an issue again, he had a tough decision to make.

He could have the surgery again and risk that it might not be as effective the second time around. Or he could venture down another avenue.

Either way, his career was at stake.

De La Rosa was in his second season as a Diamondback when it was interrupted in September by a familiar pain in his elbow.

His rookie season with the Dodgers in 2011 was cut short for the same reason. He ended up having his first Tommy John procedure.

So when the issue arose again last season, he and Dr. James Andrews who performed De La Rosas first Tommy John surgery discussed the options. They decided stem-cell therapy would be more effective than a second surgery. De La Rosa then received one stem cell injection in late September and another in December.

He has been playing catch and said he feels 100-percent healthy, but he will not begin throwing off the mound until mid-March.

What I see from it right now, its working, said De La Rosa, who will be 28 years old March 4. No more pain, no more soreness. Just waiting for my time.

Dr. Keith Jarbo is an orthopedic surgeon with OrthoArizona who specializes in elbow surgery. Jarbo, who has performed many Tommy John surgeries to repair the ulnar collateral ligament, said the procedure is less effective the second time around.

Stem-cell therapy has become more popular in orthopedics over the past five to 10 years, Jarbo said. Some doctors even use it in addition to Tommy John surgery to accelerate the healing process. He said stem cells are used because they are pluripotent, meaning they can develop into every type of cell that makes up the body.

They have a lot of the growth factors that are necessary for healing, Jarbo said. We think they can be important adjuncts for healing.

However, there is a risk. Jarbo said there is no research that compares the efficacy of stem-cell therapy to that of Tommy John surgery. With the lack of research, Jarbo said one doctor may be using different types of stem cells than another.

He said he doesnt use stem cells and wont until there is more research that shows it is effective. Until then, he cant assure his patients that stem-cell therapy will produce a ligament that has similar characteristics to what it did before the injury.

Its high-risk in the sense that we dont know exactly what its going to do, Jarbo said. We think that it promotes healing, but we dont know exactly what growth factors are within or whats going to happen.

I dont think youre necessarily getting a new, better tissue as if youre developing a robot. Youre really just trying to get good healing and strong appropriate tissue, whether thats with surgery or not.

Jarbo estimated Andrews conducts over 100 Tommy John surgeries per year. He said doctors like Andrews may be helpful in researching stem-cell therapys effectiveness if they can use stem cells on half of their patients and compare the results with the half that received Tommy John surgery.

De La Rosa is part of a group of trendsetters. Last season, Los Angeles Angels of Anaheim pitchers Garrett Richards and Andrew Heaney both received stem cell injections to stave off Tommy John surgery. Heaney ended up needing the surgery anyway.

D-backs manager Torey Lovullo said De La Rosa seems encouraged by his health.

We just know that Rubby is in a really good place, hes been throwing the ball really well hes smiling, and hes back to himself, which is always a good sign for him, he said.

Diamondbacks pitching coach Mike Butcher said stem-cell therapy is unpredictable, but seems to helping De La Rosa.

Its obviously helped out Rubby, Butcher said. The results have been good so far; he feels great. Now its just a matter of working toward the progression of where we can get him off the mound.

Jarbo said the largest risk with using stem-cell therapy may be that players are rushed back to action through an accelerated rehab program.

However, De La Rosa has been patient throughout his now five-month recovery.

He hopes it means the end of his elbow pain.

Its frustrating because sometimes you want to pitch but you cannot pitch because theres a lot of soreness, he said. When you do it right and you get hurt and everything switches, now you cant pitch with your whole motion and you have to limit a lot of things.

You get bad pitching.

Follow this link:

D-backs' De La Rosa counting on stem-cell therapy to avoid second Tommy John - Arizona Sports (registration) (blog)