What is a Tommy John Surgery?

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  • Written By: Mary McMahon
  • Edited By: O. Wallace
  • Last Modified Date: 19 October 2019
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A Tommy John Surgery is a surgical procedure in which the ulnar collateral ligament (UCL), a key ligament in the elbow, is replaced with a tendon from elsewhere in the body. This surgery is performed when the UCL starts to fail, and it is classically used on athletes, because they tend to damage this ligament more than other people, and a damaged UCL can be a career-ender. Baseball players are most likely to need UCL surgery, especially if they are pitchers.

Properly, this surgery is known as an ulnar collateral ligament reconstruction. It's called a Tommy John Surgery after the first patient to receive the surgery, who pitched for the Los Angeles Dodgers. In 1974, Doctor Frank Jobe reconstructed Tommy John's damaged UCL, and he went on to have a very successful pitching career. In the years since then, the surgery has been refined, becoming much more effective and much less invasive.

In the Tommy John Surgery, the surgeon opens the elbow up, removes the damaged ligament, and drills a series of holes in the bones around the elbow. A tendon is harvested from elsewhere in the body, often the forearm, and threaded through the holes, essentially tying the elbow together. The wound is closed, and the patient is in for about a year of recovery, including physical therapy to encourage the harvested tendon to ligamentize, pulling the bones together and stabilizing the elbow.


It is possible to achieve a full recovery after a Tommy John Surgery, and the surgery has become increasingly common. Often, people appear to perform better after the surgery than they did before, although doctors have suggested that the surgery probably brings the elbow back to peak condition, so athletes are really just performing like they used to before their UCLs were damaged. Recovery also involves a lot of careful conditioning and a slow return to demanding physical activity, and this mandatory resting period is undoubtedly beneficial.

In the 1990s, doctors began to observe a disturbing rise in the use of the Tommy John Surgery among high school athletes. They suggested that high school athletes were being overworked and overstrained, because younger bodies are typically able to withstand harder training regimens, so an athlete's schedule would have to be quite grueling for a problem with this ligament to develop. Like any surgery, the Tommy John Surgery also carries risks, and some doctors are reluctant to see it performed on young athletes for that reason as well.


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Post 8

It sounds like there have been quite a few professional baseball players who have had the Tommy John surgery and have had full recovery. A year recovery time, though, is a long time to be away from the game.

This is a bit different from high school players who are played to the point of having to have this surgery at such a young age. Professionals are independent adults, baseball is their job. The surgery is so successful that it makes sense that they would opt for surgery and recovery time, rather than give up the game.

But parents of young teen players are still responsible for them and should put pressure on coaches to ease up a little and hopefully prevent injuries.

Post 7

I'm concerned about the general trend to push young athletes in a number of sports to the point where there are way too many injuries and surgeries. With so many young boys starting so young in football and with the ever-increasing over-training and competition, concussions are becoming a big issue.

With baseball and the push to win, requires more and more training. And the end result is - well, if you get hurt and damage your elbow ligament, you can always get surgery and you may be a better player when you come back to the game.

Post 6

This is kind of weird, but I have a Tommy John autographed baseball. The weird part is that it is also signed by the surgeon who performed the landmark surgery.

I am a big baseball collector and I have a whole storage room in my basement filled with stuff. But my favorite thing to collect is signed baseballs. I picked up the Tommy John ball at an auction a few years back for a really good price. I know its kind of an oddity and I probably won't make a ton on it when I sell it but its a nice piece of the collection.

Post 5

I'm from St. Louis and I'm still riding high over the recent world series win. It was an amazing season and an even more amazing playoffs. But what is maybe most amazing about all of it is that we did it without the help of our number one pitcher Adam Wainwright.

He injured his arm right at the beginning of training camp and had to go in for tommy john surgery. He was out for the entire season. The rest of the pitching staff really stepped up, especially the bullpen, but it would have been a much easier run if we had had our ace.

Luckily he will be back next year and apparently stronger than ever. With all of our returning players I think we have a real shot at winning it again.

Post 4

Stephen Strasburg is a guy who has a real chance to have an exciting career only because of Tommy John surgery. The Nats were all excited about him, and he got out there, pitched a little while, and promptly blew out his arm! Still in his early 20s. Could have been a never-was.

But thanks to Tommy John surgery, he still has a chance. He looked good in rehab late last summer and should be back in the rotation in 2012.

Not that it will do the poor Nats any good! Wonder how long they can keep a guy like that around.

Post 3

@letshearit - I think Sandy Koufax is the one most frequently named as a great pitcher who could have had a longer career if more modern medical procedures were available in his time. There are probably many others as well.

For many years I have been hearing the television commentators pass along a recovered pitcher's opinion that he had been throwing harder than they ever could before after having had the surgery; I'm actually somewhat relieved to learn from this article that this is probably not really the case. Otherwise baseball news could have even more controversies about "performance-enhancing surgery"...

Post 2

The list of major league pitchers who have come back from Tommy John surgery is a long one indeed. It really makes you think about how many talented pitchers prior to the 1970s blew their arms out and had their careers end instantly without even a chance of making it back, especially given that pitchers threw more innings in the old days compared to today.

Tommy John surgery really is the biggest development in baseball in the past several decades. Can anyone name any great pitchers prior to the 1970s who would have benefited from this procedure to extend their careers?

Post 1

I think the idea that baseball pitching improves after the surgery may be partly to blame for all these young kids getting the surgery. Parents are surprisingly willing to have their kids cut up so they can keep playing.

After Curt Schilling pitched in the World Series with his ankle basically stapled together, parents would ask their kids' doctors if the doc couldn't just do something temporary like that so their child could finish the season. They seem to have trouble understanding that they need to think about what's best for a child in the long term. How many surgeries can one young body part be expected to undergo? How long a career can a pitcher be expected to have if he needed Tommy John surgery at fifteen?

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