Tommy John Surgery …will they get back to the majors?

Hundreds of professional baseball players have undergone elbow medial collateral ligament reconstruction (MCL; ulnar collateral ligament reconstruction UCL; tommy john surgery)

The UCL is one of the main stabilizers of the elbow during the throwing motion. It is located on the inside (or medial aspect) of the elbow. Throwing a baseball places a tremendous amount of stress on the ligament. In fact, research has shown that the stress generated by each pitch approaches the maximum load that the ligament can withstand. The reason why it doesn’t tear more frequently is that other muscles of the forearm help stabilize the elbow. Additionally, the larger muscles of the body including the legs, core and shoulder help protect against injury.

When the ligament tears, players will get pain on the inside of their elbow. Sometimes, if it is an acute injury, the player will describe hearing or feeling a “pop” on the throw. More commonly, these injuries are chronic or acute-on-chronic in nature. Baseball players may complain of decreased throwing velocity, poor control or the feeling that it takes longer to loosen up. A physical exam performed by a sports medicine specialist will typically make the diagnosis. It is confirmed with an MRI. Imaging studies can assess the degree of injury, which can range from a minor sprain to a complete tear. While sprains and even small partial tears can frequently be treated with rest and physical therapy; complete tears typically require surgical intervention.

The surgery is often referred to as Tommy John Surgery, named after the first player to undergo the procedure. Since that time, it has saved the careers of thousands of baseball players. The procedure typically involves taking a tendon from one’s wrist or knee. This graft is fed through drill holes made in the bones of the forearm (the ulna) and the upper arm (humerus) in the same locations as the native ligament to reconstruct the torn ligament. The surgery itself only takes about 45 minutes. Unfortunately, it is the rehabilitation process that causes the long time necessary for complete recovery.

Recovery focuses on improving motion and strength in both the shoulder and elbow. Flaws in throwing mechanics that may have contributed to the ligament damage are addressed during this recovery period. Athletes typically begin throwing at about 4 months after surgery. They progress to throwing off a mound by about 7 or eight months. Professional pitchers typically take about a year to get back to their previous level of play. Even then, it often takes another year to until their statistics are similar to their preinjury levels.

Since Dr. Frank Jobe performed the first UCL reconstruction on Tommy John, the procedure has been modified to make it safer and more successful. Today, most orthopedic surgeons who perform the procedure will quote their patients an 85-90% success rate. This applies to even the highest-level baseball players like Mariano Rivera, Tim Hudson, and Chris Carpenter, all of whom have undergone UCL reconstruction earlier in their careers.

Posted in: General Sports Medicine Information, Practice News, Uncategorized