Tommy John surgery,
known by doctors as ulnar collateral ligament 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
, or foot
of the patient). The procedure is common among collegiate and professional players 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.
After the tendon from the forearm of the 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
bone that are part of the elbow joint.
There is a risk of damage to the ulnar nerve.
Chances of a complete recovery after surgery are estimated today at 85 to 90 percent. 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. Today, the procedure takes about an hour. Full rehabilitation
takes about a 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.
The ulnar collateral ligament can become stretched, frayed, or torn through the reptitive 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.
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. 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 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 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.
Today, the surgery is becoming more common in children 10-18 years old due to increased season length, the rise of travel teams (and tournament play), and the more frequent use of breaking pitches
by young pitchers.
In some cases baseball pitchers throw harder after the procedure than they did beforehand. As a result, orthopedic surgeons like Dr. James Andrews are reporting 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 that he could before their UCL started to degrade.
List of baseball players receiving the surgery
All are pitchers unless otherwise noted.
List of football players receiving the surgery