The Problem with Tommy John Surgery


Braves starting pitcher Tim Hudson threw eight shutout innings against the Giants on Saturday night, allowing just three hits in a 3-0 win. The Tommy John surgery reclamation project walked only one and struck out six, improving to 4-0 with a sparkling 0.63 ERA. The 35 year old right hander has only given up only two runs during his win streak in a total of 28.2 innings.

"I located my sinker really well, changed speeds with my cutter," said Hudson. "Change their eye level as much as I can. Stay down in the zone other than that." He threw 112 pitches, 76 for strikes, while picking up his 13th win of the year.

On Friday, in the article I wrote on 2010 NL Cy Young candidates and mentioned that Hudson is more in the 'honorable mention' category. It should be noted that it's not because of his lack of credentials. Some of the other pitchers competing for the crown like Adam WainwrightJosh Johnson, Ubaldo Jimenez, and Mat Latos are just having ridiculous years. It's like we're revisiting 1968 all over again...... Lower the mound!  Check out the top 10 MLB ERA's in 1968.

  1. Bob Gibson (STL) 1.12
  2. Luis Tiant (CLE) 1.60
  3. Sam McDowell (CLE) 1.81
  4. Dave McNally (BAL) 1.95
  5. Denny McLain (DET) 1.96
  6. Tommy John (CHW) 1.98 - Yes, that Tommy John.....
  7. Bobby Bolin (SFG) 1.99
  8. Stan Bahnsen (NYY) 2.05
  9. Bob Veale (PIT) 2.05
  10. Jerry Koosman (NYM) 2.08

After posting that article and looking at the list of potential NL Cy Young names as a group, one thing that stood out and jumped off the screen at me. Tim Hudson and Josh Johnson are both Tommy John surgery survivors. That lead me to thinking....Is this the start of a trend a trend? Have they now perfected the surgery so well that we going to start seeing players who have had Tommy John surgery pitch like Cy Young candidates regularly? Are players that are stuck in the minors going to start having the surgery on healthy arms so that they can get to the majors? Are journeyman middle relievers going to throw away 18 months of their career and have the surgery so they can become top of the rotation starters and make the big money?

The Surgery

Baseball players and fans call it "Tommy John surgery", after the pitcher who was the first to have the surgery 29 years ago. By any designation, it is one of the major advancements in sports medicine in the last quarter century.

Tommy John surgery, known in medical practice as "ulnar collateral ligament (UCL) reconstruction," is a surgical procedure in which a ligament in the medial elbow is replaced with a tendon from elsewhere in the body (often from the forearm, hamstring, knee, or foot of the patient). The procedure is common among collegiate and professional athletes in several sports, most notably baseball. The surgery is named after Tommy John, a pitcher who was the first professional athlete to successfully undergo the operation in 1974.

In 2009, published reports placed the chances of a complete recovery after said surgery at approximately 85 to 92 percent. At the time of Tommy John's operation, Dr. Frank Jobe, who did the surgery, put his chances at 1 in 100. After his surgery in 1974, John spent 18 months rehabilitating his arm, returned for the 1976 season, and went on to pitch in the major leagues until 1989 at age 46. The procedure can take about one hour. Full rehabilitation takes about one year for pitchers and about six months for position players. Usually, pitchers who have the surgery can get their full range of motion back after about two months and can then start doing weight exercises. For the next four months, they can increase the weight that they use and start doing exercises on all parts of their arm.

In a July 2003 interview with USA Today, according to the renowned Birmingham, Ala., orthopedic surgeon Dr. James Andrews, only about 20% of the UCL surgery patients of his office were big leaguers. Another 20%-25% his patients were minor league professionals, but the majority were college or high school athletes.

Coming into the 2010 season, here's a list of 180 professional baseball players known to have had Tommy John surgery.  Most, not all, have been pitchers.

You now have MLB teams that just assume that players will be better after the surgery. The 2003 the article brings to light when the Yankees signed free agent Jon Lieber, a former 20-game winner, to a two-year contract with $3.5 million guaranteed when he was just five months into his rehabilitation! He wasn't even going to pitch for them for another year!

Earlier in this article I brought up the question of whether or not players would consider having this surgery on healthy arms. At the time I wrote that, it was partly in jest. However, after continuing my research on this topic, I found to my amazement that there are people out here actually inquiring about doing it! I can't imagine any certified doctor doing that to a healthy arm, however if we were to find out that there was, with all the crazy medical happenings we find out these days, would that really shock you?

In some cases baseball pitchers throw harder after the procedure than they did beforehand. As a result, orthopedic surgeons like Dr. James Andrews have reported that increasing numbers of parents are coming to them and asking them to perform the procedure on their un-injured sons in the hope that this will increase their performance.

However, many people-including Dr. Frank Jobe, the doctor who invented the procedure-believe any supposed post-surgical increase in performance is generally due to two factors. The first is pitchers' increased attention to conditioning. The second is that in many cases it can take several years for the UCL to deteriorate. Over these years the pitcher's velocity will gradually decrease. As a result, it is likely that the procedure simply allows the pitcher to throw at the velocity he could before his UCL started to degrade.

This entire discussion brings into question whether or not a player competing with a surgically repaired elbow in this matter is competing with a surgically "repaired" or "enhanced" elbow. Is it fair to take a larger, stronger healthy ligament from another part of one's body and let the pitcher use it to throw? While it's clearly a different way of going about it, are the results any different than someone taking PED's to make the ligament larger and stronger?

Tim Hudson and Josh Johnson are having fantastic years. Without having had the surgery, they would no longer even be making a livelihood pitching. Yes, they have been rehabilitated from injury, no one can question that, but have they and many others been surgically enhanced? If pitchers having Tommy John Surgery are going to routinely become dominating top of the rotation starters and back and relievers, this is a question that is going to have to be addressed going forward.

Science and technology are advancing faster than sports can keep up. This may be great for society and the standard of living for many, but do we want to start having body part replacements have an effect on the outcome of sporting events? We are now cultivating body parts for esthetics and function of people who are in need of improving their quality of life. As this process becomes more refined, it's only a matter of time before someone uses this ability to attempt to get an edge....... Mike Cardano

Mike is the founder of Around the Horn Baseball & Xtra Point Football

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