Tommy John Surgery: The Truth Revealed?

One of the most important moments in baseball history wasn’t a milestone achievement, an everlasting play that will forever be replayed on highlight shows, or even some great trade made by a general manager.  It didn’t happen on the field, in the owner’s box, or in the clubhouse.  It happened when a down-on-his-luck pitcher walked into Dr. Frank Jobe’s office without any other options. 

Tommy John just wasn’t willing to give up.  Prior to the invention of the ulnar collateral ligament replacement surgery this type of injury was considered a death sentence.  Pitchers were simply considered to have a dead arm and they either disappeared or tried to struggle through it.  It’s believed that Sandy Koufax’s career could have been saved if the procedure had existed in 1966.  Hundreds of careers were lost, in contrast, today nearly one in seven pitchers have been saved by this operation.

More than three decades have passed since September 25, 1976 when the operation was first performed, but there are still many unknowns and myths surrounding this procedure.  Amazingly, no in-depth studies have been conducted on the players returning from the injury, so pretty much everything we think we know is based off speculation.

The only study that exists was conducted by Brett W. Gibson of the Penn Sports Medicine Center in Philadelphia.  These were his findings: 

“Of 68 Major League Baseball pitchers who underwent the surgery between 1998 and 2003, 82 percent returned to play within an average of 18.5 months post-surgery with no chance in average ERA or walks or hits per innings pitched.”

Baseball people have accepted those figures as fact for a number of years.  With all the useless information on the internet, why has no one ever kept track of radar readings?  I know I’m not the only one out there that would visit the site that hosted this information.   I spent countless hours “googling” different phrases and turned up nothing.  The reason this information is so valuable is because many people have claimed to come back with a little extra mustard on their fastball, but there is no hard evidence to back up this theory.  Essentially making the claim impossible to prove.

Billy Koch, who blew out his arm in his third appearance in 1997, typically threw in the high-90s.  When he returned from the disabled list USA Today reported that he hit as high as 108 mph (which is highly unlikey, gut who am I too argrue?).  In 2003 Kerry Wood claimed that in the years following his 1999 operation he was throwing harder than ever.  I’d like to think he was imagining things, but considering that he topped 200 strikeouts in the three seasons following his operation it’s hard to make that case.   It should also be noted that he never hit 100 mph until after the surgery.

So why isn’t everyone lining up to get the four inch scar that goes along with the added velocity?  Well, actually they are.  Several of the leading orthopedists have reported that many teenage ball players come to them with healthy arms or minor injuries looking for an upgrade.  Dr. James Andrews, the leading physician in his field, recently explained in a New York Times article that the extra heat, if it exists at all, comes from the physical therapy and rehab that is done in post-op recovery.  He also has a few theories that can explain this hoax:  young pitchers begin to throw harder as they mature, players are comparing the speed from when they are injured to the postoperative velocity, and pitchers often improve their mechanics during rehab while also making their bodies stronger.  Lastly, the repaired arms are pain free and rested.

“We don’t want to advertise that we can make you a better pitcher by the Tommy John procedure; that’s misleading,” explains Dr. Andrews.  “The increased velocity isn’t true by any stretch of the imagination.  For the ones that do it, the reason is all the hard work, all the throwing exercises and the development from all the exercises they’d probably never done before.”

The procedure is no longer a death sentence, so it doesn’t make sense to put it off when the warning signs appear.  Some clubs will allow a player to struggle for years trying in an attempt too circumvent the operation until their elbows snap like a curve ball.  In this era they should just step in when the red flags start showing up and force them to get it repaired.  It seems as though the longer the wait the harder it is to come back.  Why wait until the ligament is nearly shredded and risk further injury?  Atlanta pitcher Mike Hampton was disabled with forearm soreness in 2005.  It was later discovered that he had a UCL injury.  It was successfully repaired but he continues to struggle with elbow problems that are reportedly unrelated.  You have to wonder if they would have got it right from the start if things would have turned out differently.

Even though some clubs are reluctant, most now opt to go under the knife for partial tears instead of wasting time trying to heal through rest and rehab.

“The non-surgical success rate healing these partial tears is a lot lower that we initially thought,” Andrews says.  “It’s a 50-50 chance they’ll heal with conservative treatment.”

With the new success rates and improved arms, some people have suggested that teams should start using the procedure as a precaution when they draft a player.  They state that their new prospects could study the intricacies of the game while taking away the possibility of losing them down the road.  I’m a firm believer in the “if it ain’t broke don’t fix it” theory, so this seems a little far fetched to me.  Especially since no evidence exists to support the surgically enhanced pitcher theory.

Francisco Liriano might be the best subject for a case study.  He was one of the top pitchers in the league last year before he went down in the second half.  The Twins opted for the surgery almost immediately; he is due back next year. 

The mystery is still out on the Tommy John surgery.  Too many variables exist to prove anything.  For each Billy Koch that returns with a little extra zip there’s a Jimmy Key that comes back a soft tosser.  If Francisco Lirano comes back throwing 105 mph heaters there will be a couple extra bodies in Dr. Andrew’s waiting room even though it probably has nothing to do with his new tightly wound ligament.