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Tommy John surgery, known in medical practice as ulnar collateral ligament (UCL) reconstruction, is a surgical procedure in which a ligament in the medial elbow is replaced with a tendon from elsewhere in the body (often from the forearm, hamstring, knee, or foot of the patient). The procedure is common among collegiate and professional athletes in several sports, most notably baseball.

The surgery is named after Tommy John, a pitcher for the Los Angeles Dodgers who was the first professional athlete to successfully undergo the operation in 1974. The procedure was performed by Dr. Frank Jobe, who also serves as a Special Advisor to Los Angeles Dodgers chairman Frank McCourt.

Contents

Process

After the tendon from the forearm of the same or opposite elbow or below the knee is harvested it is then woven in a figure-eight pattern through tunnels that have been drilled in the ulna and humerus bone that are part of the elbow joint.

There is a risk of damage to the ulnar nerve.[1]

Recovery

In 2009, chances of a complete recovery after surgery are estimated at 85 to 92 percent[2]. At the time of Tommy John's operation, Jobe put his chances at 1 in 100. After his surgery in 1974, John spent 18 months rehabilitating his arm, returned for the 1976 season, and went on to pitch in the major leagues until 1989 at age 46. The procedure can take about one hour. Full rehabilitation takes about one year for pitchers and about six months for position players. Usually, pitchers who have the surgery can get their full range of motion back after about two months and can start doing weight exercises. For the next four months, they can increase the weight that they use and start doing exercises that emphasize all parts of their arm.

Risk factors

The ulnar collateral ligament can become stretched, frayed, or torn through the repetitive stress of the throwing motion. The risk of injury to the throwing athlete's UCL of the elbow is thought to be extremely high as the amount of stress through this structure approaches its ultimate tensile strength during each and every hard throw[3].

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[4]. The 2002 study followed 426 pitchers aged 9 to 14 for one year, and studied their throwing volume, pitch type, and throwing mechanics. Compared to pitchers who threw 200 or fewer pitches in a season, players 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 curve ball was associated with an increase in shoulder pain. There was only a weak correlation between throwing mechanics perceived as bad and injury. Thus, although there is a large body of other evidence that suggests mistakes in throwing mechanics increase the likelihood of injury[5] 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[6].

In younger athletes for whom the growth plate (the medial epicondylar physis) is still present, the "opening up" force at the inside of the elbow during throwing is more likely to fail at this region than at the Ulnar Collateral Ligament. This injury is often termed "Little League Elbow," and does not require reconstructing the Ulnar Collateral Ligament.

Misconceptions

In some cases baseball pitchers throw harder after the procedure than they did beforehand. As a result, orthopedic surgeons like Dr. James Andrews have reported that increasing numbers of parents are coming to them and asking them to perform the procedure on their un-injured sons in the hope that this will increase their performance. However, many people—including Dr. Frank Jobe, the doctor who invented the procedure—believe any supposed post-surgical increase in performance is generally due to two factors. The first is pitchers' increased attention to conditioning. The second is that in many cases it can take several years for the UCL to degrade. Over these years the pitcher's velocity will gradually decrease. As a result, it is likely that the procedure simply allows the pitcher to throw at the velocity he could before his UCL started to degrade. [7] There are also examples of pitchers, like Francisco Liriano of the Minnesota Twins, who could not throw as hard after having the surgery as they could beforehand.[8]

List of baseball players having received the surgery

All are pitchers unless otherwise noted.

List of softball players receiving the surgery

  • Lindsey Twigg

List of football players receiving the surgery

References

  1. ^ Purcell DB, Matava MJ, Wright RW (2007). "Ulnar collateral ligament reconstruction: a systematic review". Clin. Orthop. Relat. Res. 455: 72–7. doi:10.1097/BLO.0b013e31802eb447. PMID 17279038. 
  2. ^ Rosenhek, Eric (2009-07-01). "The gory details of Tommy John surgery". The Good Point. http://www.thegoodpoint.com/baseball/jul09/the-gory-details-of-tommy-john-surgery.html. Retrieved 2006-07-03. 
  3. ^ Fleisig, G.S., The biomechanics of baseball pitching, in Biomechanical Engineering. 1994, University of Alabama: Birmingham. p. 163.
  4. ^ Lyman, S., et al., Effect of pitch type, pitch count, and pitching mechanics on risk of elbow and shoulder pain in youth baseball pitchers. Am J Sports Med, 2002. 30(4): p. 463–8.
  5. ^ Whiteley, R., Baseball throwing mechanics as they relate to pathology and performance - a review. Journal of Sports Science & Medicine, 2007. 6(1): p. 1–20.
  6. ^ Lyman, S., et al., Longitudinal study of elbow and shoulder pain in youth baseball pitchers. Med Sci Sports Exerc, 2001. 33(11): p. 1803–10.
  7. ^ Keri, Jonah (2007-09-13). "Interview With Dr. Frank Jobe". ESPN.com. http://static.espn.go.com/mlb/columns/bp/1431308.html. Retrieved 2008-10-13. 
  8. ^ http://bleacherreport.com/articles/186748-liriano-still-trying-to-succeed-with-slower-stuff
  9. ^ Pearlman, Jeff (2008-03-25). "Brian Anderson's baseball death, and resurrection". ESPN.com. http://sports.espn.go.com/espn/print?id=3311307&type=story. Retrieved 2008-10-12. 
  10. ^ Quinn, T.J.; Red, Christian; O'Keeffe, Michael; Madden, Bill (2007-09-10). "Rick Ankiel received 12-month supply of HGH, News learns". New York Daily News. http://www.nydailynews.com/sports/baseball/2007/09/06/2007-09-06_rick_ankiel_received_12month_supply_of_h.html. Retrieved 2008-10-12. 
  11. ^ Spencer, Lyle (2005-08-12). "Notes: Ashby angling for return; Right-hander offers Padres veteran experience". MLB.com. http://sandiego.padres.mlb.com/news/article.jsp?ymd=20050812&content_id=1168025&vkey=news_sd&fext=.jsp&c_id=sd. Retrieved 2008-10-12. 
  12. ^ Rubin, Adam (2008-08-17). "Mets add Nats reliever Luis Ayala to struggling bullpen". New York Daily News. http://www.nydailynews.com/sports/baseball/mets/2008/08/17/2008-08-17_mets_add_nats_reliever_luis_ayala_to_str.html. Retrieved 2008-10-12. 
  13. ^ Radcliffe, J.R. (2007-04-21). "Notes: Backe making swift progress; Right-hander to face live batters next week". MLB.com. http://mlb.mlb.com/news/article.jsp?ymd=20070421&content_id=1922424&vkey=news_hou&fext=.jsp&c_id=hou. Retrieved 2008-10-12. 
  14. ^ a b Brown, Tim (2007-11-08). "Hot Stove Daily: Baltimore Orioles". Yahoo! Sports. http://sports.yahoo.com/mlb/news?slug=ti-orioleshotstove110807&prov=yhoo&type=lgns. Retrieved 2008-10-12. 
  15. ^ McAdam, Sean (2008-07-18). "For Baldelli, it's been one step up, two steps back". ESPN.com. http://sports.espn.go.com/mlb/columns/story?id=3490813. Retrieved 2008-10-12. 
  16. ^ Schulman, Henry (2007-06-25). "ROD BECK: 1968-2007; Resilient closer used guts, guile; 38-year-old found dead at home". San Francisco Chronicle: p. D-1. http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2007/06/25/SPGRFQL6KG1.DTL. Retrieved 2008-10-12. 
  17. ^ Stone, Larry (2008-02-10). "Erik Bedard: Quiet ace won't be bragging". Seattle Times. http://seattletimes.nwsource.com/html/highschoolsports/2004174633_bedard100.html. Retrieved 2008-10-12. 
  18. ^ "Fantasy news: Francis Beltran". CBSSports.com. http://fantasynews.sportsline.com/fantasybaseball/players/updates/284573. Retrieved 2008-10-12. 
  19. ^ Bowman, Mark (2007-09-21). "Bennett adds chapter to dream story; Right-hander strikes out eight as Braves beat Brewers". MLB.com. http://mlb.mlb.com/news/gameday_recap.jsp?ymd=20070920&content_id=2220772&vkey=recap&fext=.jsp&c_id=atl. Retrieved 2008-10-12. 
  20. ^ a b c d e f g h i j Carroll, Will; Gorman, Thomas (2004-09-22). "Inside Tommy John Surgery: Thirty Years of Fixing Pitchers". Baseball Prospectus. http://www.baseballprospectus.com/article.php?articleid=3486. Retrieved 2008-10-13. 
  21. ^ "Ordonez to provide annual scholarship". MLBPlayers.com. 2008-01-16. http://mlbplayers.mlb.com/pa/news/article.jsp?ymd=20080116&content_id=2347477&vkey=mlbpa_news&fext=.jsp. Retrieved 2008-10-13. 
  22. ^ McDonald, Joe (2005-05-10). "Healthy Billingsley Pitches for Another Chance". NY Sports Day. http://www.mofosports.net/news/bears/1115750463.html. Retrieved 2008-10-13. 
  23. ^ http://www.smdailyjournal.com/article_preview.php?id=56981 Lee, Emanuel, "Former CSM star hits the big time," The Daily Journal, 4/6/06, accessed 8/14/09]
  24. ^ TSN.ca. Jay's Litsch to have Surgery, Out for Season. June 9, 2009. http://www.tsn.ca/mlb/teams/story/?id=281384&hubname=mlb-blue_jays
  25. ^ http://web.minorleaguebaseball.com/milb/stats/stats.jsp?pos=&sid=milb&t=p_pbp&pid=447816

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