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|Tommy John surgery|
|Tommy John surgery|
Tommy John Surgery, known in medical practice as ulnar collateral ligament (UCL) reconstruction, is a surgical graft procedure in which the ulnar collateral ligament in the medial elbow is replaced with a tendon from elsewhere in the body. The procedure is common among collegiate and professional athletes in several sports, most notably baseball.
The procedure was first performed in 1974 by orthopedic surgeon Dr. Frank Jobe, then a Los Angeles Dodgers team physician who today serves as a special advisor to the team. It is named after former major league pitcher Tommy John, the first baseball player to undergo the surgery, whose 288 career victories ranks seventh all time among left-handed pitchers. The initial operation, John's successful post-surgery career, and the relationship between the two men is the subject of a 2013 ESPN 30 for 30 Shorts documentary.
The patient's arm is opened up around the elbow. Holes to accommodate a new tendon are drilled in the ulna and humerus bones of the elbow. A harvested tendon (often the palmaris tendon)—from the forearm of the same or opposite elbow, below the knee (known as the patellar tendon), or from a cadaver—is then woven in a figure-eight pattern through the holes and anchored. The ulnar nerve is usually moved to prevent pain as scar tissue that forms can apply pressure to the nerve.
At the time of Tommy John's operation, Jobe put his chances at 1 in 100. In 2009, prospects of a complete recovery had risen to 85–92 percent.
Following his 1974 surgery, John missed the entire 1975 season rehabilitating his arm before returning for the 1976 season. Before his surgery, John had won 124 games. He won 164 games after surgery, retiring in 1989 at age 46.
The UCL can become stretched, frayed, or torn through the repetitive stress of the throwing motion. The risk of injury to the throwing athlete's ulnar collateral ligament of elbow joint is thought to be extremely high as the amount of stress through this structure approaches its ultimate tensile strength during a hard throw. R.A. Dickey, however, became a very successful Major League Baseball pitcher despite having no UCL in his pitching arm.
While many authorities suggest that an individual's style of throwing or the type of pitches they throw are the most important determinant of their likelihood to sustain an injury, the results of a 2002 study suggest that the total number of pitches thrown is the greatest determinant. A 2002 study examined the throwing volume, pitch type, and throwing mechanics of 426 pitchers aged 9 to 14 for one year. Compared to pitchers who threw 200 or fewer pitches in a season, those who threw 201–400, 401–600, 601–800, and 800+ pitches faced an increased risk of 63%, 181%, 234%, and 161% respectively. The types of pitches thrown showed a smaller effect; throwing a slider was associated with an 86% increased chance of elbow injury, while throwing a curveball was associated with an increase in pain. There was only a weak correlation between throwing mechanics perceived as bad and injury-prone. Thus, although there is a large body of other evidence that suggests mistakes in throwing mechanics increase the likelihood of injury it seems that the greater risk lies in the volume of throwing in total. Research into the area of throwing injuries in young athletes has led to age-based recommendations for pitch limits for young athletes.
In younger athletes, for whom the growth plate (the medial epicondylar epiphysis) is still open, the force on the inside of the elbow during throwing is more likely to cause the elbow to fail at this point than at the ulnar collateral ligament. This injury is often termed "Little League elbow" and can be serious but does not require reconstructing the UCL.
Some baseball pitchers believe they can throw harder after Tommy John Surgery than they did beforehand. As a result, orthopedic surgeons have reported that parents of young pitchers have come to them and asked them to perform the procedure on their un-injured sons in the hope that this will increase their sons' performance. However, many people—including Dr. Frank Jobe, the doctor who invented the procedure—believe any post-surgical increases in performance are most likely due to the increased stability of the elbow joint and pitchers' increased attention to their fitness and conditioning. Jobe believes that, rather than allowing pitchers to gain velocity, the surgery and rehab protocols merely allow pitchers to return to their pre-injury levels of performance.