Sizemore underwent surgery Thursday in Philadelphia to correct a sports hernia that has troubled him since May. The center fielder's continuing knee problems convinced the Tribe that this was an appropriate time as any to tackle two issues with one knife.
After the brief procedure -- Dr. Bill Meyers needed all of 20 minutes to stitch up Sizemore and send him on his way -- the center fielder is expected to need between four to six weeks to recover. Cleveland is hopeful that will provide enough time for both the abdominal and knee pain to heal.
"We're cautiously optimistic," Indians head athletic trainer Lonnie Soloff said, "that in four to six weeks he's going to return to full baseball activities."
That puts Sizemore and sidelined right fielder Shin-Soo Choo (broken left thumb) both on pace to potentially return to the lineup by late August or early September. In the meantime, Cleveland is left with a depleted outfield that was also without Michael Brantley and Travis Buck for the past two games.
Brantley missed games in Minnesota on Tuesday and Wednesday after a bout with heat exhaustion led to a severely upset stomach. Buck was struck on the head by a pitch from Twins lefty Francisco Liriano on Tuesday and sat out Wednesday's game with a powerful headache, but no signs of concussion.
The Tribe was left with an outfield consisting of Luis Valbuena, rookie Ezequiel Carrera and Austin Kearns on Wednesday. Even with Brantley and Buck possibly back in the mix on Friday, it is clear that the Indians would benefit from reeling in outfield help before the July 31 non-waiver Trade Deadline.
"That's an understatement," Indians manager Manny Acta said earlier this week. "How can you substitute the absence of Choo and Grady Sizemore? I don't think that's a secret. We know that from top to bottom and we're working on it. But people need to understand, too, that it takes two to tango.
"You can have all the Christmas lists and wishes and all that, but you need to have somebody that you can engage with."
Top names being floated as available include Hunter Pence of the Astros and Carlos Beltran of the Mets, but the Indians do not intend to part with one of their top core prospects. Other possibilities include Josh Willingham, Ryan Ludwick, Jeff Francoeur, Melky Cabrera and Coco Crisp, and Cleveland surely has had conversations about each.
As for Sizemore, the good news for the Indians is that MRI exams on his ailing right knee have not shown a similar breakdown as the imaging exams did last year with his left knee. Last season, he injured his left knee in April, again in May and then required mircrofracture surgery in June that led to a grueling 10-month rehab.
Sizemore does not appear headed down that road this time around.
"He's going to make a full recovery here," Soloff said.
This season, Sizemore injured his right knee (described as a bone bruise) and suffered the sports hernia during a slide into second base on May 10. He missed two weeks while on the 15-day disabled list and did not look the same upon being activated. On Sunday, Sizemore tweaked his right knee while rounding first base in Baltimore.
Sizemore had been playing through the discomfort of the sports hernia, and he hit .214 with a .289 on-base percentage and a .377 slugging percentage in 43 games from May 27 through Sunday. The initial plan was for him to undergo abdominal surgery in the offseason, but the recent setback with the knee, and the required recovery time involved, made it logical to get the hernia operation taken care of now.
"When Grady initially contused his knee joint in May," Soloff explained, "we were hopeful that 15 days would allow it to resolve enough to allow him to both play and perform at a high level. He was comfortable playing and performing for the 10 weeks that he did.
"With the injury on Sunday, clearly he hit a point now where he's unable to play as a result of his knee symptoms. The clinical examination of his right knee is different now than it was in May, just in the sense that he's having more symptoms.
"It's a little more painful to walk, to squat, to get himself in baseball-specific activities. That combined with an unchanged MRI scan tells us that he's going to need more than two weeks to put the knee in a position to return to activities.
"That's what initiated the conversation to get the sports hernia -- or the athletic pubalgia -- addressed during that time."
Sizemore underwent an athletic pubalgia operation, also performed by Dr. Meyers, in September of his injury-plagued 2009 season. Soloff noted that the injury two years ago was more severe, adding that the Sizemore is scheduled to begin a walking rehab program as soon as Friday.
As for baseball-specific drills, Soloff noted that it would probably be at least three weeks before such activities are introduced to Sizemore's rehab. Asked if Sizemore could benefit from altering his all-out style of play -- which has contributed to six DL stints and four operations in the past three seasons -- Soloff said it is not that simple.
"Grady plays the game very aggressively," Soloff said. "Sometimes, injury results from aggressive play, but that's what makes Grady Grady. He knows one way on the baseball field and that's to give all that he has. To ask an athlete to change how he plays the game could perhaps lead to other compensatory injuries."
Soloff did not rule out the possibility that the sports hernia -- initially described as hip discomfort by Sizemore -- negatively affected the center fielder's production. On the season, Sizemore has hit .234 with 10 homers and 29 RBIs in 60 games, with the bulk of his struggles coming after the ill-fated slide in May.
"It's likely that his symptoms in the hip were affecting how Grady was running," Soloff said. "Although, it wasn't obvious to just to watch him run -- he didn't have an obvious altered gait or things like that. There's no question that there were small variations in how he was running."
Sizemore is hoping the latest surgery can help avoid such issues later this year.
"The injury which resulted in today's surgery," Sizemore said, "has been bothering me since the slide in May. Knowing the two areas are related, and also learning my knee condition is not serious, gives me peace of mind going forward that I can finish the season healthy and help contribute to an exciting pennant chase."