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AAOS 2014 Annual Meeting Wrap Up: Pitchers’ performance on the mound may not be the same after Tommy John Surgery

One name that strikes fear into every pitcher, manager, and owner in Major League Baseball is Tommy John.  However, if you are not a baseball fan, it may be difficult to see how the name of a former LA Dodgers’ Pitcher in the 70s can cause such a stir.  Well, when Tommy John was a pitcher for the Dodgers, he tore a ligament in his elbow called the Ulnar Collateral Ligament (UCL).  At the time, this was a career ending injury that plagued many pitchers.  However, Tommy John, then a 31 year old star, approached Dodgers’ team physician, Frank Jobe, about performing surgery to repair it.  In 1974, at the hands of surgical pioneer the late Dr. Frank Jobe, Tommy had a 6” piece of tendon harvested from his arm, and surgically implanted around the injured elbow ligament.  According to the Los Angeles Times, Jobe had borrowed the idea from procedures he had performed on the damaged joints of Polio patients.  The surgery was a huge success, and Tommy went on to win 168 games after the procedure.  The ground-breaking new procedure came to be known as “Tommy John” surgery. Although the injury is no longer classified as career-ending, the surgery still results in loss of a season for a pitcher, extensive rehab, and major costs to the team. Hence why the name “Tommy John” causes most pitchers and managers to cringe. According to a Medpage today article, recent research presented at the AAOS 2014 annual meeting suggests that Tommy John surgery may have more impact than previously thought.

To date, 186 MLB pitchers have elected for Tommy John surgery, including some of the greats, from David Wells, to John Smoltz, and Kerry Wood. For most, it has not been a career ending procedure, as 87% of pitchers who received the procedure returned to the mound. However, Keller et al. presented statistics at the AAOS 2014 annual meeting which suggested that pitchers had “reduced effectiveness” upon returning to the major leagues.  In addition, Keller found that pitchers showed performance declines in the year before they had surgery, indicating overuse in the pitching arm and the potential need for reconstructive surgery.  In fact, Brian Cole MD, Professor of Orthopedics at Rush University Medical Center, stated, ”Many (players) opt for surgery because they can see their performance declining”.

Keller said the study was performed to “see what impact undergoing the surgery had on major league performance”.  With the incidence of Tommy John surgery increasing in recent years, it seems logical to assess its impact on game performance, rather than just return-to-sport. Keller’s statistics shed light on the diminishing returns of a pitcher who undergoes this procedure, and arouses questions about how to properly manage pitchers to avoid surgery, identifying signs of overuse, and future treatment options. As surgical technique and medical technology advances, the Tommy John procedure may potentially evolve to include less down time and improved performance outcomes. However, It is possible that in the future, Orthobiologic therapies such as Platelet Rich Plasma (PRP) and Bone Marrow Concentrate (BMC) could be used as alternative treatments for less severe forms of UCL injury, or as a possible adjunct to surgical repair.

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