Tommy John and a Second Chance

Mention the name "Tommy John" to anyone who watches Sportcenter and they immediately know that it means that a pitcher had some kind of operation in order to elongate the pitcher's career and "fix" their throwing arm. "Tommy John" surgery is the common name for Ulnar Collateral Replacement Surgery and there are a litany of pitchers, both professional and amateur, have had this procedure. Most people, avid baseball fans included, don't know the specifics of what Tommy John is and what it entails. Let's delve into the history and application of Tommy John Surgery and discuss just a few of baseball's superstars who have had this surgery:



Tommy John Surgery, or UCR surgery, is defined as a surgical graft procedure in which a ligament in the medial elbow is replaced with a tendon from elsewhere in the body; often from the forearm, hamstring, hip, knee, or foot of the patient) or from a cadaver doner (see diagram left). The procedure is common among collegiate and professional athletes in several sports, most notably baseball. Basically in non-medical terms, a person blows out or rips the ligament in their elbow and has it replaced by a shiny new one; much like blowing out a tire and putting on a new one.

I chose this particular subject, because the Major League leader in ERA, Brandon Beachy of the Atlanta Braves, tore his UCL and underwent Tommy John last week. The procedure was first performed in 1974 by Dr. Frank Jobe, who today serves as a Special Advisor to the LA Dodgers, and is named after former major league pitcher Tommy John; whose 288 career victories ranks seventh all time among left-handed pitchers.

The necessity of the Tommy John surgery became prevelant due to the wear and tear a pitcher goes thru during the longest season in all of sports; 162 regular season games, plus spring training and the postseason. The UCL can become stretched, frayed, or torn through the repetitive stress of the throwing motion. Anyone who has ever thrown something extremely hard and then felt soreness in the ebow region has placed stress on the UCL; now imagine throwing a baseball thousands upon thousands of times.

Back to the procedures namesake, Tommy John; Thirty-seven baseball seasons have passed since the very first UCL replacement surgery. John was 31 years old with 124 wins and 11 seasons under his belt. He never threw heat like Strasburg or Smoltz, instead he relied on a bottom-out sinker that forced ground balls. But the three pitchers, as well as many others who have undergone UCL reconstruction, have one thing in common: a mechanical flaw in the timing of their deliveries that causes the arm to lag behind the rest of the body, putting extra stress on the shoulder and elbow. The very nature of how a baseball is thrown by a pitcher (overhand, rather than the ergonomically correct underhand) generates enough force on each pitch to rupture the ulnar collateral ligament in the elbow. To throw a baseball properly, a pitcher must get into the right position at the right time with the right succession of movements, like dominoes falling.

After John's procedure in 1974, he spent the entire 1975 season recovering. At the time when John came back in 1976, he posted a 10-10 win/loss record that, at the time, was considered miraculous. Tommy went on to pitch until 1989 and posted 164 wins during that period. Having personally known Sandy Koufax, who had retired in 1966 at age 30 after a short but brilliant career, that a damaged UCL meant you were done. With this successful surgery, and subsequent recover, it effectively gave all pitchers hope that if the most important ligament in their throwing arms were to give way, their career was not necessarily over.

Despite the inevitable year-long stint on the DL that rehab from the surgery requires, teams and pitchers seem to barely flinch at the diagnosis of a compromised UCL. "It's become an accepted side effect of the job," says George Paletta, the Cardinals' head team physician and orthopedic surgeon. That's because the surgery works; 92 percent of elite pitchers with reconstructed UCLs return to their prior level of competition for at least a year.

The list of Tommy John surgery recipients include: Deion Sanders (strangly NOT a pitcher), Jamie Moyer (the 76 year old who was demoted to the minors by the Rockies a few weeks ago), John Smoltz, Stephen Strausberg, Kerry Wood, Eric Gagne, Tim Hudson and a whole laundry list that reaches into the hundreds. Soon to be added to the list of successful UCL replacement surgeries will be Brandon Beachy of the Atlanta Braves (God willing).

God-given genetic superiority and freakish athletic ability often help those with less-than-ideal pitching mechanics make it to the majors, which is why you will find shockingly few exemplars of pitching mechanics on Tuesday Night Baseball. "Everyone knows smoking is bad for you, yet people still smoke," says Yankees pitching coach Larry Rothschild. "It's the same with pitching. I've seen guys who don't have great mechanics pitch for a long time. The body adjusts."

Until it doesn't, then a consultation and ultimately "Tommy John Surgery" courtesy of Dr. James Andrews (doctor to the athletes et al.)

Here is a top 10 list of pitchers who have had successful Tommy John surgeries courtesy of Sports Illustrated:

http://sportsillustrated.cnn.com/multimedia/photo_gallery/1103/mlb-tommy-john-surgery/content.1.html