A popular topic of interest in the areas of sports medicine and baseball orthopedics of late is that of the Tommy John surgery (TJS) “epidemic” in Major League Baseball. As a member of the not-so-exclusive Tommy John Surgery brotherhood myself, I would like to take the time to clear up some misconceptions and maybe help some people understand just what exactly this procedure is, the history behind it and some shocking statistics that may raise some eyebrows.
For those (such as myself) who spend much of their indoor lives with some brand of ESPN playing in the background, the term “Tommy John surgery” is certainly not a foreign concept. However, what exactly is going on in the baseball world probably eludes even the most practiced of couch potatoes. So what is the procedure? For starters, TJS is an elbow surgery, and if you’re the guy from Chick-fil-A who showed me his “TJ scar” on his right shoulder, then I’m talking to you. In order to qualify for Tommy John, you must first tear your ulnar collateral ligament (UCL), which is located on the inside of your elbow. Symptoms of a UCL tear include pain in the aforementioned area when throwing or lifting and possible tingling in the pinky and ring finger from swelling on the ulna nerve (or funny bone). I actually still can’t feel my fingers and it has been almost three months since the surgery. In order to repair a torn UCL, the doctor will remove a tendon from a forearm, knee or hamstring, drill holes in the surrounding bones of the elbow, and use the new tendon to reinforce the joint. Tommy John recipients can be identified by a distinct four inch scar on the inside of the elbow.
So why is it called Tommy John surgery? Most people think that it’s because the first doctor to perform the procedure was named Tommy John, but it was actually the player. The brainchild behind the revolutionary surgery was Dr. Frank Jobe who, in 1974, originally gave Tommy John a one in 100 chance of ever throwing another baseball. Not only did Tommy John throw again, but he played 14 more Major League seasons and won more games after the surgery than before. Another misconception is that only baseball pitchers get Tommy John surgery. Anybody who tears their UCL is eligible to get the reconstruction from the everyday gym rat to the over-zealous ping pong player. Position players and pretty much anybody who throws is especially subject to tear a ligament. For example, I am a catcher who needed the surgery. Several college wrestlers and even NFL all-pro cornerback Richard Sherman have needed the procedure (though Sherman never went through with it).
The final most common and, frankly, most frustrating misconception is that most players (and 20 percent of coaches) think that TJS gives the patient a competitive advantage in terms of throwing velocity. While the new ligament is nearly five times as strong as the previous one, this is absolutely not true. The only reason that a player may come back throwing harder is due to the new attention given to arm care and body conditioning that comes as a result of rehabilitation. In fact, there are actually parents of teenage pitchers who have come to my surgeon and requested that he reconstruct a completely healthy arm. Regarding this phenomenon, HALF of surveyed high school pitchers believe that Tommy John surgery should be administered even with no signs of an injury.
Some final quick facts regarding Tommy John surgery:
- It takes anywhere from 10 months to two years to recover from the surgery (average 15 months).
- Unlike the original 1 percent estimate, doctors now give athletes a 90 percent chance to return to competition after the procedure.
- The surgery itself, not counting prep and cleaning time, only lasts about 60 to 90 minutes.
- The average number of surgeries needed from Major League Baseball every year has nearly doubled in the past three years (all time high of 36 in 2012).
- There are more repeat, or “revision,” surgeries than ever.
- More than ONE THIRD of all MLB pitchers have had the surgery.
- Fifteen percent of people actually lack the tendon that is most commonly used to fix the UCL tendon during Tommy John surgery.
