What is Tommy John Surgery? Ulnar Collateral Ligament (UCL) Reconstruction, better known as Tommy John Surgery, is a procedure performed on the ligament that connects the bone of the upper arm, the humerus, to a bone in the forearm, the ulna. The UCL is a critical ligament in the elbow, and allows athletes, particularly baseball players, to throw a baseball at speeds in excess of 100 miles per hour (MPH). A baseball player named Tommy John, a pitcher who played from 1963 to 1989, was the first person to ever have UCL reconstruction surgery. Due to the fact that John was the first player to be operated on, the surgery bears his namesake.

Who was Tommy John? Tommy John was a professional baseball player that pitched for 7 different teams during his 26-year career. John injured his left pitching elbow during a game on July 17, 1974. He threw a pitch, as he had done many times before, and felt a sharp pain in his elbow upon releasing the ball. John was removed from the game, and was evaluated by the Los Angeles Dodgers team doctor, Dr. Frank Jobe. Jobe informed Tommy John that if he did not have surgery, his career would be over. The surgery had never yet been performed before Tommy John was injured. After months of evaluation and deliberation, John agreed to the surgery. On September 25, 1974, Tommy John became the first man to receive the experimental surgery.

How is the surgery performed? Dr. Jobe decided to take a tendon from somewhere else in the body, ideally the forearm, hamstring or foot, and to drill holes in the elbow to wrap the newly implanted ligament in a figure eight pattern. This pattern allows the UCL to repair itself naturally, while forcing the humerus and ulna to stay together during the long healing process.

How long is the Rehabilitation process? For 16 weeks after the surgery is performed, the player is encouraged to not even attempt to throw a baseball. There is a 5-step rehab process, which emphasizes that the player must be pain free before moving on to the next step. Even after the player begins a throwing program to regain arm strength, the normal recovery time is still 8-11 months away from full recovery. It is worth noting, that full recovery is a very loosely utilized term. Dr. James Andrews, a renowned orthopedic surgeon, claims that 10% to 20% of the players who receive the surgery do not regain their full pre operation arm strength and pitch velocity.

Will a player who has undergone the procedure come back stronger? There has been a lot of success enjoyed be recipients of the procedure. 85% to 90% of players that undergo the procedure have a full recovery. However, statistics show that a player won’t necessarily regain their old form just because they underwent the surgery. Tommy John’s story was a successful one, but the surgery isn’t foolproof. Many of the players that have had the surgery reinjure the elbow later in their career.

How often does the injury occur? Between 1974 and 1999, the surgery was performed 99 times. Only 7 of those surgeries were performed on a non-pitcher. Since 2000, however, the procedure has been performed 734 times, on both pitchers and regular position players. Dr. Andrews has been quoted as calling this jump in surgeries a sports injury epidemic.

Why has the injury been occurring more frequently? Many physicians, including Dr. Andrews, attribute the rising frequency of this UCL injury to overuse of the elbow from a young age. More and more young athletes are encouraged to focus on one sport early on in life. This singular sport approach denies athletes the opportunity to develop the versatile muscle growth that playing multiple sports can help build. While focusing on one sport can be beneficial to a young player, the repetitive arm motion can wear down and weaken the UCL. This leads to a higher possibility of injury to the elbow in the future.

What steps can be taken to help prevent the injury? By simply cutting down on the amount of pitches thrown by a player, parents and coaches can help decrease the incredible rise of UCL injuries, thereby decreasing the need for so many Tommy John surgeries. An emphasis on pitching mechanics can also help develop a solid foundation for a young athlete to build off of. Another very easy step to take would be decreasing the amount of time that the player plays baseball. Baseball has been adapted from a summer pastime, to a year round sport. Many of the young players that focus solely on baseball, play the sport with very little time off during the year. This constant stress on the ligament can be very damaging in the long term. There is no way of knowing whether this type of injury and related surgery will continue into the future, but if nothing changes, regarding injury prevention, then this injury trend may very well continue.