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If Pineda has a long, healthy career it would shift my opinion on the high elbow. I can't see any other flaws, but I also haven't seen any super-slow motion video and am far from an expert.
I'm not expecting it though. Everytime I wonder if a Wainwright or Scherzer is about to be an exception, they go and get injured.
But its not a death sentence. Wainwright had three 200+ IPs MLB seasons before having his TJ and he pitched a lot in the minors too (with some long DL stints in between). Pineda hasn't had that minor league wear-and-tear on his arm so its entirely possible that he remains relatively healthy for the 5 years we control him.
That said, Pineda is a year-to-year guy. Hes not someone like Verlander or Felix that that you lock up to a long-term deal.