Tommy John surgery
|Tommy John Surgery (TJS)|
Tommy John surgery (TJS), known in medical practice as ulnar collateral ligament (UCL) reconstruction, is a surgical graft procedure in which the ulnar collateral ligament in the medial elbow is replaced with a tendon from elsewhere in the body. The procedure is common among collegiate and professional athletes in several sports, most notably baseball.
The procedure was first performed in 1974 by orthopedic surgeon Dr. Frank Jobe, then a Los Angeles Dodgers team physician who served as a special advisor to the team until his death in 2014. It is named after the first baseball player to undergo the surgery, major league pitcher Tommy John, whose 288 career victories ranks seventh all time among left-handed pitchers. The initial operation, John's successful post-surgery career, and the relationship between the two men is the subject of a 2013 ESPN 30 for 30 documentary.
The patient's arm is opened up around the elbow. Holes to accommodate a new tendon are drilled in the ulna and humerus bones of the elbow. A harvested tendon, such as the palmaris tendon from the forearm of the same or opposite elbow, the patellar tendon, or a cadeveric tendon, is then woven in a figure-eight pattern through the holes and anchored. The ulnar nerve is usually moved to prevent pain as scar tissue can apply pressure to the nerve.
At the time of Tommy John's operation, Jobe put his chances at 1 in 100. In 2009, prospects of a complete recovery had risen to 85–92 percent.
Following his 1974 surgery, John missed the entire 1975 season rehabilitating his arm before returning for the 1976 season. Before his surgery, John had won 124 games. He won 164 games after surgery, retiring in 1989 at age 46.
For baseball players, full rehabilitation takes about one year for pitchers and about six months for position players. Players typically begin throwing about 16 weeks after surgery. While eighty percent of players return to pitching at the same level as before the surgery, for those Major League pitchers who receive the surgery twice, thirty five percent do not return to pitch in the majors at all.
The UCL can become stretched, frayed, or torn through the repetitive stress of the throwing motion. The risk of injury to the throwing athlete's ulnar collateral ligament of elbow joint is thought to be extremely high as the amount of stress through this structure approaches its ultimate tensile strength during a hard throw. R.A. Dickey, however, became a very successful Major League Baseball pitcher despite having no UCL in his pitching arm.
While many authorities suggest that an individual's style of throwing or the type of pitches they throw are the most important determinant of their likelihood to sustain an injury, the results of a 2002 study suggest that the total number of pitches thrown is the greatest determinant. A 2002 study examined the throwing volume, pitch type, and throwing mechanics of 426 pitchers aged 9 to 14 for one year. Compared to pitchers who threw 200 or fewer pitches in a season, those who threw 201–400, 401–600, 601–800, and 800+ pitches faced an increased risk of 63%, 181%, 234%, and 161% respectively. The types of pitches thrown showed a smaller effect; throwing a slider was associated with an 86% increased chance of elbow injury, while throwing a curveball was associated with an increase in pain. There was only a weak correlation between throwing mechanics perceived as bad and injury-prone. Thus, although there is a large body of other evidence that suggests mistakes in throwing mechanics increase the likelihood of injury it seems that the greater risk lies in the volume of throwing in total. Research into the area of throwing injuries in young athletes has led to age-based recommendations for pitch limits for young athletes.
In younger athletes, whose epiphyseal plate (growth plate) is still open, the force on the inside of the elbow during throwing is more likely to cause the elbow to fail at this point than at the ulnar collateral ligament. This injury is often termed "Little League elbow" and can be serious but does not require reconstructing the UCL.
Increasingly often, pitchers require a second procedure after returning to pitching - the periods from 2001-2012 and 2013-2015 both saw eighteen Major League pitchers going under the knife a second time. As of April 2015, the average amount of time between procedures is 4.97 years.
Some baseball pitchers believe they can throw harder after Tommy John Surgery than they did beforehand. As a result, orthopedic surgeons have reported that parents of young pitchers have come to them and asked them to perform the procedure on their un-injured sons in the hope that this will increase their sons' performance. However, many people—including Dr. Frank Jobe—believe any post-surgical increases in performance are most likely due to the increased stability of the elbow joint and pitchers' increased attention to their fitness and conditioning. Jobe believed that, rather than allowing pitchers to gain velocity, the surgery and rehab protocols merely allow pitchers to return to their pre-injury levels of performance.
List of notable baseball players who underwent the surgery
- Brett Anderson (pitcher)
- Rick Ankiel (pitcher converted to outfielder)
- Brandon Beachy (pitcher, twice)
- Érik Bédard (pitcher)
- Joe Beimel (pitcher)
- Kyle Blanks (infielder/outfielder)
- A. J. Burnett (pitcher)
- Chris Carpenter (pitcher)
- Joba Chamberlain (pitcher)
- Shin-Soo Choo (right fielder)
- Alex Cobb (pitcher)
- Patrick Corbin (pitcher)
- Manny Corpas (pitcher)
- Neal Cotts (pitcher)
- Yu Darvish (pitcher)
- Jacob deGrom (pitcher) 
- Josh Edgin (pitcher) 
- Scott Erickson (pitcher)
- Scott Feldman (pitcher)
- José Fernandez (pitcher)
- Éric Gagné (pitcher)
- A. J. Griffin (pitcher)
- Joel Hanrahan (pitcher)
- Matt Harvey (pitcher)
- Ty Hensley (pitcher)
- Mario Hollands (pitcher)
- Daniel Hudson (pitcher; twice)
- Tommy John (pitcher)
- Josh Johnson (pitcher, twice)
- Casey Kelly (pitcher)
- John Lackey (pitcher)
- Ryan Madson (pitcher)
- Kris Medlen (pitcher, twice)
- Matt Moore (pitcher)
- Charlie Morton (pitcher)
- Jamie Moyer (pitcher)
- Joe Nathan (pitcher)
- Ivan Nova (pitcher)
- Jarrod Parker (pitcher, twice)
- Mike Pelfrey (pitcher)
- José Rijo (pitcher)
- Miguel Sano (third baseman)
- Ben Sheets (pitcher)
- John Smoltz (pitcher)
- Joakim Soria (pitcher)
- Stephen Strasburg (pitcher)
- Brent Strom (pitcher)
- Jameson Taillon (pitcher)
- Christian Vazquez (catcher)
- Adam Wainwright (pitcher)
- Jake Westbrook (pitcher)
- Duke Welker (pitcher)
- Zack Wheeler (pitcher) 
- Matt Wieters (catcher)
- Brian Wilson (pitcher, twice)
- Kerry Wood (pitcher)
- Jordan Zimmermann (pitcher) 
- Joel Zumaya (pitcher)
- Grantland staff (July 23, 2013). "30 for 30 Shorts: Tommy and Frank". Grantland. Retrieved August 17, 2013.
- Carroll, Will. "Dr. Frank Jobe, Tommy John and the Surgery That Changed Baseball Forever". Bleacher Report. Turner Broadcasting System, Inc. Retrieved July 17, 2013.
- Rosenhek, Eric (July 1, 2009). "The gory details of Tommy John surgery". The Good Point. Retrieved April 6, 2014.
- Dodd, Mike (July 29, 2003). "A year of rehab for Tommy John patients". USA Today.
- Verducci, Tom. "The post-Tommy John surgery calculus that is changing the game". Sports Illustrated (April 21, 2015). Retrieved 21 April 2015.
- Fleisig, G.S., The biomechanics of baseball pitching, in Biomechanical Engineering. 1994, University of Alabama: Birmingham. p. 163.
- Schwarz, Alan (February 27, 2008). "New Twist Keeps Dickey's Career Afloat". The New York Times.
- Lyman, Stephen; Fleisig, Glenn S.; Andrews, James R.; Osinski, E. David (2002). "Effect of Pitch Type, Pitch Count, and Pitching Mechanics on Risk of Elbow and Shoulder Pain in Youth Baseball Pitchers". The American Journal of Sports Medicine 30 (4): 463–8. PMID 12130397.
- Whiteley, Rod (2007). "Baseball throwing mechanics as they relate to pathology and performance – A review" (PDF). Journal of Sports Science and Medicine 6 (1): 1–20. doi:10.1111/j.1600-0838.1996.tb00062.x.
- Lyman, Stephen; Fleisig, Glenn S.; Waterbor, John W.; Funkhouser, Ellen M.; Pulley, Leavonne; Andrews, James R.; Osinski, E. David; Roseman, Jeffrey M. (2001). "Longitudinal study of elbow and shoulder pain in youth baseball pitchers". Medicine and Science in Sports and Exercise 33 (11): 1803–10. doi:10.1097/00005768-200111000-00002. PMID 11689728.
- Tommy John epidemic in MLB?
- Purcell, Derek B; Matava, Matthew J; Wright, Rick W (2007). "Ulnar Collateral Ligament Reconstruction". Clinical Orthopaedics and Related Research 455: 72–7. doi:10.1097/BLO.0b013e31802eb447. PMID 17279038.
- Longman, Jere (July 20, 2007). "Fit Young Pitchers See Elbow Repair as Cure-All". nytimes.com. Retrieved October 23, 2013.
- Keri, Jonah (September 13, 2007). "Interview With Dr. Frank Jobe". ESPN.com. Retrieved October 13, 2008.
- Slusser, Susan (July 15, 2011). "A's Brett Anderson out for a year after surgery". San Francisco Chronicle. Retrieved July 15, 2011.
- Quinn, T.J.; Red, Christian; O'Keeffe, Michael; Madden, Bill (September 10, 2007). "Rick Ankiel received 12-month supply of HGH, News learns". New York Daily News. Retrieved October 12, 2008.
- "Brandon Beachy to have Tommy John surgery on Friday". CBSSports.com. Retrieved April 7, 2015.
- Constantine Madias. "MLB: Adam Wainwright, Roy Oswalt and the Top 10 Young Aces Threatened By Surgery". Bleacher Report. Retrieved April 7, 2015.
- "Beimel brings veteran presence to bullpen battle". Major League Baseball. Retrieved April 7, 2015.
- "Padres' Kyle Blanks slated for Tommy John surgery - HardballTalk". nbcsports.com. Retrieved April 7, 2015.
- Thirty-fifth anniversary of Tommy John surgery Kansas City Star
- "Choo's big league path faces obstacles". mlb.com. February 22, 2008.
- "Rays pitcher Alex Cobb to have season-ending elbow surgery". ESPN.com. Associated Press. May 8, 2015. Retrieved May 8, 2015.
- Dulberg, Dave (March 25, 2014). "Arizona Diamondbacks left-hander Patrick Corbin underwent season-ending, Tommy John surgery". ArizonaSports.com. Retrieved March 25, 2014.
- Carroll, Will; Gorman, Thomas (September 22, 2004). "Inside Tommy John Surgery: Thirty Years of Fixing Pitchers". Baseball Prospectus. Retrieved October 13, 2008.
- "The long, improbable comeback of Neal Cotts". CSN Chicago. June 9, 2013. Retrieved July 2, 2013.
- "Yu Darvish of Texas Rangers to undergo Tommy John surgery". ESPN.com. Retrieved April 7, 2015.
- Vorkunov, Mike (March 23, 2014). "As Tommy John surgery remains vexing issue, Mets' rebuild is guided by approach to preserve young pitchers". The Star-Ledger. Retrieved September 22, 2014.
- "Josh Edgin to have elbow surgery". ESPM. Retrieved March 16, 2015.
- "Cubs pitcher Scott Feldman starts camp as starter - Chicago Sun-Times". Suntimes.com. February 14, 2013. Retrieved March 7, 2014.
- "Miami Marlins ace Jose Fernandez has Tommy John surgery". ESPN.com. Retrieved April 7, 2015.
- Slusser, Susan (April 30, 2014). "A’s A.J. Griffin has Tommy John surgery". San Francisco Chronicle. Retrieved April 30, 2014.
- "Joel Hanrahan undergoes Tommy John surgery - HardballTalk". nbcsports.com. Retrieved April 7, 2015.
- "Matt Harvey undergoes Tommy John surgery".
- Brudnicki, Alexis (April 6, 2015). "Ty Hensley Has Tommy John Surgery". Baseball America. Retrieved April 6, 2015.
- Gross, Stephen (April 8, 2015). "Mario Hollands has Tommy John surgery; Ethan Martin, Miguel Alfredo Gonzalez shutdown". The Morning Call. Retrieved April 8, 2015.
- Brock, Corey (March 22, 2013). "Prospect Kelly to have Tommy John surgery". MLB.com. Retrieved February 24, 2014.
- "John Lackey suffers biceps strain in first start back from Tommy John surgery". Retrieved October 31, 2013.
- March 2012 "Madson returns to camp, surprised by injury".
- "Kris Medlen of Atlanta Braves to get second Tommy John surgery". ESPN.com. Retrieved April 7, 2015.
- "Matt Moore of Tampa Bay Rays undergoes Tommy John surgery". ESPN.com. Retrieved April 7, 2015.
- pittsburgh (June 13, 2013). "Giants smoke Pirates in Charlie Morton's return to the big leagues – City of Champions – A site dedicated to covering Pittsburgh Sports". Cityofchampionssports.com. Retrieved July 2, 2013.
- "Jamie Moyer has Tommy John surgery". espn.com. ESPN. Retrieved December 2, 2010.
- The Star Ledger. May 1, 2015. pg. 33
- "Nova to have season-ending Tommy John surgery". New York Yankees. Retrieved April 7, 2015.
- Slusser, Susan (March 17, 2014). "A’s Jarrod Parker to miss season – Tommy John surgery again". San Francisco Chronicle. Retrieved April 30, 2014.
- "Most Popular". CNN. September 10, 2001.
- "Twin prospect Miguel Sano headed for Tommy John surgery, will miss 2014". Yahoo Sports. March 1, 2014. Retrieved April 7, 2015.
- "Smoltz faces season-ending surgery". Major League Baseball. Retrieved April 7, 2015.
- "Washington Nationals' Stephen Strasburg has Tommy John surgery – ESPN". Sports.espn.go.com. September 4, 2010. Retrieved July 2, 2013.
- "Ultimate Astros » Brent Strom, second to undergo Tommy John surgery, recalls Dr. Frank Jobe". Blog.chron.com. July 14, 2008. Retrieved March 7, 2014.
- "Vazquez to undergo Tommy John surgery". Boston Red Sox. Retrieved April 7, 2015.
- Gold, Derrick (February 24, 2011). "Wainwright set for Tommy John surgery". St. Louis Post-Dispatch.
- "Westbrook throws off regulation mound". mlb.com. March 13, 2009.
- "Minor Leaguer Welker has Tommy John surgery". Pittsburgh Pirates. Retrieved April 7, 2015.
- "Mets Pitcher Zack Wheeler Has Tommy John Surgery". The New York Times. Retrieved March 25, 2015.
- "Matt Wieters to undergo season-ending Tommy John surgery". CBSSports.com. Retrieved April 7, 2015.
- "Kerry Wood writes storybook ending to injury-plagued career". USA Today. Retrieved July 26, 2013.
- Boswell, Thomas. "Nationals Journal – Zimmermann Will Miss 18 Months". Voices.washingtonpost.com. Retrieved July 2, 2013.
- USA Today article
- OC Family Magazine article on avoiding Tommy John injury in young pitchers
- The gory details of Tommy John surgery (from TheGoodPoint.com)
- What pitchers need to know about Tommy John surgery (from TopVelocity.net)