Ulnar Collateral Ligament Reconstruction Surgery

There is one name managers hate to hear mentioned when talking about their pitchers: Dr. James Andrews.

Because seeing Andrews likely means that a member of their pitching staff has a serious arm problem and, more often than not, requires Ulnar Collateral Ligament reconstruction surgery, as it is known in medical jargon. Or, as it is more commonly known, Tommy John surgery.

The procedure is named after the first professional athlete to require this surgery, former big league pitcher Tommy John. In the middle of the 1974 season, John tore his UCL, the ligament in his pitching elbow that is the subject of the surgery. Dr. Frank Jobe, a doctor for the Los Angeles Dodgers, the team that John was currently employed by, was assigned to John’s case. The initial diagnosis was that John was most likely never to pitch again.

So John asked Dr. Jobe to “make something up (to repair the tendon)” but Dr. Jobe could not find a substance to replace the ruptured tendon with. However, John’s request to “make something up” intrigued Dr. Jobe and after careful planning, Tommy John went under the knife on September 25^th, 1974 in an unparalleled procedure.

Dr. Jobe thought about Tommy’s response, to just repair the tendon. While no synthetic device would work, Dr. Jobe decided that the UCL tendon could be replaced with one of two other tendons in your body; one in the opposite arm’s forearm or one below the knee (In John’s case, it was from his right forearm). After the tendon is collected, it is sewn in a figure-eight pattern through holes that have been drilled in two bones in the elbow joint. The same procedure is done today for UCL reconstruction surgery and it generally takes an hour.

However, according to surgeons, the surgery isn’t even half of the battle, it’s rehab. For Tommy John, it took him 18 months between surgery and his next major league appearance. Now, rehab time is down to about a full calendar year for pitchers (position players can halve that). Patients can now get full range of motion in their arm two months after the surgery and can begin a rigorous rehab. In 1974, Dr. Jobe put John’s chances at a comeback at 1 out of 100. Now, Dr. Andrews estimates about an 85-90 percent chance at complete recovery.

Tommy John beat the low odds handed down by his physician. He pitched in 14 more seasons after the surgery, winning 20 games twice. He won 164 games after his surgery, one fewer than Dodger legend Sandy Koufax had in his entire career. Ironically, some doctors think that Koufax’s arm problems that forced an early retirement generated from his UCL. Had the surgery been available at the time, his career may have been prolonged.

A question often pondered is why do pitchers throw harder after Tommy John Surgery? Throwing a baseball overhand is an unnatural motion for the body to do. With every pitch or throw, the UCL will tear, stretch or fray. When the tendon is replaced, the patient basically gets a brand new tendon in his elbow, allowing him to hit his peak for throwing velocity, instead of the 80-90% he would get from his partially damaged tendon each appearance. Dr. Jobe also believes conditioning plays a factor in the increased velocity, since pitchers after the surgery will normally pay more attention to arm conditioning then they would have pre-surgery. USA Today reported that between 2002-2003, 75 pitchers appeared in the major leagues with a four-inch scar on their throwing elbow, left from the surgery. Pitchers whose elbows have gone under the knife include John Smoltz, Mariano Rivera, Ryan Dempster, Kenny Rogers and B.J. Ryan. Position players to have the surgery include Carlos Quentin and Xavier Nady. A few pitchers, including Mike Riley and Jose Rijo, have had the surgery done three times and have come back and pitched professionally again.

It is no question that Dr. Jobe’s procedure has benefited many baseball players at all levels. Some such as Smoltz and Rivera will likely go on to Cooperstown, probably not having plaques emblazoned with their names at the Hall of Fame if it weren’t for Dr. Jobe’s legendary surgery. Maybe some day, Dr. Frank Jobe will have his own plaque in Cooperstown.