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"Tommy John" surgery: a career-saving procedure for many pitchers

Baseball Digest, May, 2004 by Mike Dodd

WRIGLEY FIELD, A LAZY WEDnesday afternoon in an early-season game last year between the San Diego Padres and Chicago Cubs.

Unexceptional, really, except for the starting pitchers with the four-inch long scars on the sides of their fight elbows.

Adam Eaton and Kerry Wood, with fastballs clocking in the mid-90s mph, pitch seven strong innings each and strike out a total of 23 batters. The box score--a 2-0 Padres victory--is testament to a career-saving surgery now as routine as it is remarkable.

The doctors call it a UCL--ulnar collateral ligament reconstruction.

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Baseball players and fans call it Tommy John surgery, after the pitcher who was the first to have the surgery 30 years ago. By any designation, it is one of the major advancements in sports medicine in the last quarter century.

More than 75 pitchers who have appeared in the major leagues the last two seasons have the scar that goes with the injury and surgery--about one out of every nine.

Only about 20 percent of the UCL surgery patients of James Andrews, the renowned Birmingham, Alabama, orthopedic surgeon, are big leaguers. Another 20-25 percent are minor league professionals, but the majority are college or high school athletes.

These players typically perform as well, if not better, after the operation and have stronger arms, with radar gun readings to match.

"I hit my top speed (in pitch velocity) after the surgery," says Wood, the Cubs' 26-year-old All-Star. "I'm throwing harder, consistently."

"It felt so good when I came back, I said I recommend it to everybody ... regardless what your ligament looks like," Chicago White Sox reliever Billy Koch says jokingly. He blew out his elbow in his third professional appearance, in 1997.

A torn elbow ligament once was a pitcher's sentence to the broadcast booth or the monthly autograph show at the local Holiday Inn. No longer.

Andrews, who performed about 150 UCL reconstructions in the last year, says the success rate for major league pitchers is about 85 percent.

"It's pretty much a sure thing," says John, now pitching coach for the Class AAA Edmonton Trappers, a Montreal Expos affiliate.

"Tip your hat to modern medicine," says Toronto starter Pat Hentgen, who entered his second full season back from the surgery in 2004. "As far as the way my arm feels, it feels like it never happened."

Clubs are no longer wary of drafting pitchers who have had the surgery, and the Yankees went a step further in the winter of 2002. They signed free agent Jon Lieber, a former 20-game winner, to a two-year contract with $3.5 million guaranteed when he was just five months into his rehabilitation. "It showed me a lot about how far the surgery has come," Lieber says.

The surgical procedure hasn't changed much since it was pioneered by Frank Jobe for John in 1974. A tendon is removed from the patient's wrist or hamstring and grafted into the elbow--woven in a figure-eight pattern through tunnels drilled in the humerus and ulna bones.

Doctors typically complete the operation in about an hour--less than one-third of the time it first took--and an overnight hospital stay frequently is not required.

The procedure is not unlike that done for reconstructive surgery of the anterior cruciate knee ligament (ACL) that has revived the careers of many pro football players. "I call it the anterior cruciate (surgery) of the elbow," Andrews says. As an advancement, "Which one is more important? It depends whether you're a baseball player or a running back."

"The credit goes to Frank," says Lewis Yocum of Los Angeles, Jobe's partner and the other prominent UCL specialist. Yocum averages about 100 of the surgeries a year. Before the breakthrough, the sport saw top pitchers such as Sandy Koufax retire with elbow problems referred to simply as "the generic dead arm," he says.

"People with a torn ligament were sent back to the farm or wherever they came from," says Jobe, who still assists on the surgeries. "But Tommy didn't want to go."

Rehab for a career, not a year

Though the surgical procedure has been refined, the major advancements have come in the post-operative rehabilitation, increasing the success rate from about 60 percent a decade or so ago, Andrews says.

"We've learned how much you can accelerate them and how much you can't," he says.

The surgery requires a full year of rehabilitation and typically another year pitching before returning to pre-injury form.

Essentially, the body must convert a tendon into a ligament, get it carrying blood again and train it to start working as a ligament. (A ligament connects bones, stabilizing a joint. A tendon attaches muscle to the bone.) It is very weak immediately after the surgery, and the rebuilding process must be gradual.

The elbow is immobilized in a hard brace for about a week, then the patient begins exercises to regain limited range of motion the second week. By the second or third week, he can use the arm for everyday tasks like eating and combing his hair. He can start swinging a golf club after three months and usually begin a light-tossing program at four months.

"Tommy John" surgery: a career-saving procedure for many pitchers

Baseball Digest, May, 2004 by Mike Dodd

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