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Major League Baseball's Most Talked About Surgery

Tommy John surgery is performed on athletes who have overuse injuries in the ulnar collateral ligament (UCL). The UCL is located on the inner side of the elbow. It helps to keep the elbow joint in place and prevent dislocation.
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What is Tommy John Surgery?

Tommy John surgery is performed on athletes who have overuse injuries in the ulnar collateral ligament (UCL). The UCL is located on the inner side of the elbow. It helps to keep the elbow joint in place and prevent dislocation. The UCL takes on a lot of stress with overhead throwing motions, and for that reason it is one of the most commonly-injured ligaments in throwing athletes. Specifically, the acceleration and cocking phases of throwing tend to strain the UCL the most. In some cases, the ligament may just become inflamed, but in more severe cases, the UCL can actually tear or avulse off the bone entirely.

Why is it called Tommy John Surgery?

If the surgery is performed on the UCL, how did it come to be called Tommy John surgery? We often hear of different treatment methods being named after the doctors who pioneered them, but that isn't the case this time. Rather, this procedure, known in the medical world as UCL reconstruction surgery, was named after its first recipient. Tommy John was a pitcher for the Los Angeles Dodgers in 1974 when he sustained a devastating UCL tear in the middle of a game. Dr. Frank Jobe, the team's orthopedic surgeon, told John that he would never pitch again without surgery-- although Dr. Jobe put the odds of a successful outcome at 1 percent.

The risk? The surgery had never been performed before. John decided to take his chances and underwent the procedure. On September 25, 1974, Dr. Jobe made history by performing this successful surgery. Little did he know, this was a game changer that would increase the longevity of many pitcher's careers in the major and minor leagues.

Although John missed one season to recover, he went on to pitch in 13 more seasons. From then on, the procedure was known as Tommy John surgery by baseball fans.
The procedure may have been unheard of in 1974, but today it is quite commonplace among baseball players as a way to extend their careers. Dr. Jobe passed away on March 6, 2014; however, his legacy for "changing the game" will never pass.

What is the Outcome of Tommy John Surgery?

A common issue with UCL injuries is a decrease in pitch speed due to weakness in the ligament. The torn UCL cannot be stitched back together. During Tommy John surgery, the damaged or torn UCL is reconstructed using a tissue graft. By reconstructing the ligament with a healthy tissue graft, surgeons drill into the ulna and humerus and sew in the graft. This graft is the new UCL, able to endure the stress involved in the pitching motion.

One study evaluated Major League Baseball players who underwent Tommy John surgery between 1986 and 2012, comparing them with players who did not have UCL injuries. The study found that only 2.8 percent of pitchers were unable to return to pitching after surgery, and most of them performed as well, if not better than those who did not have UCL injuries.

However, other studies have indicated that the success may be due to more than just the surgical procedure. Baseball players who have the most success and improvement after surgery worked extensively with physical therapists and athletic trainers. The improved UCL strength, combined with the extra rehab work and time to heal, are all factors in the improvement to these players' pitch speeds.

In general, research supports most players who undergo Tommy John surgery return to their pre-injury pitching abilities; however, the procedure doesn't make them any less likely to sustain future injuries, and many still saw the same decrease in pitch speed with age as other players who never had a UCL injury.

Still, many players have found success after undergoing Tommy John surgery. Matt Harvey of the New York Mets underwent the surgery in 2013 and made a great return in his first game back this April. Another Mets player, Jacob deGrom, found that his pitching improved after surgery. Other players who have recently undergone the surgery, including the New York Yankees pitcher Ivan Nova and Jose Fernandez of the Miami Marlins, have had successful procedures and are getting closer to getting back in the game.

We have to remember that Tommy John surgery is not a quick fix; it requires a rehabilitation close to one year, and no results are guaranteed. The player needs to put in the work for this procedure to be completely successful, and that usually means sitting out for an entire season to fully recover. Even then, it may be possible that an athlete will need a revision procedure in the future, although the MLB estimates that only 2-4 percent of pitchers need a revision procedure.

So what led me to write an article about Tommy John Surgery now?

As I attended my son's most recent baseball game, I heard screaming and cheering that I haven't heard at a sporting event in a while. It was the final game in the playoff series for boys fast pitch 14-16 age group. The pitcher was striking out batters left and right. The moment I had turned to watch, he had just gotten his 4th "K" in a row. There was a palpable buzz in the air at 8 a.m. Joey (the talented pitcher) and his team went on to win convincingly. They advanced to the championship game starting at 3 p.m. As I sat in the stands for what was sure to be an exciting game, Joey returned to the mound. He went on to pitch in two games in a row, 13 innings total, and with no time to rest his arm.

My interest in the game died down after I saw the parents and coaches continue their unbridled endorsement for his strike-outs. My instincts told me that Joey will never reach his full potential; rather one day he'll feel badly that he couldn't throw as fast as he once did in little league. Joey, a talented athlete, unfortunately is a classic example of an overuse UCL injury waiting to happen. All of which can be easily be prevented with understanding proper guidelines for pitch count, especially for little leaguers.

Learn more about common sports injuries and tips to prevent them on our blog.
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