Tommy John Surgery

by Jonathan Leshanski
May 27, 2005

You may not remember much about the career of Tommy John, a left hander that played over 26 years in the majors for five different organizations including the Indians, the White Sox, the Yankees, the Dodgers and the Angels. He racked up a career record of 288-231 between 1963 and 1989 and while his numbers have fallen short of Hall of Fame standards, his name is among the most well known by the modern baseball fan.

That’s because of the surgery that carries his name and is perhaps the most famous in baseball today. The surgery is technically called ulner collateral ligament replacement surgery, but is known to baseball fans simply as Tommy John surgery.

So, what the heck is the ulnar collateral ligament?

This ligament is also known as the medial collateral ligament and it’s the main ligament that hold the bones of the lower arm (the ulna and radius) and those of the upper arm (the humerus) together at the elbow and it prevents them from moving in an abnormal way (side to side).

When that ligament ruptures, the joint of the elbow becomes unstable and the main result is an injury that used to be mixed in with all other types of arm injuries; it has been referred to as “Dead Arm”. It’s not a painful injury but one that robs a pitcher of both velocity and control since the arm shifts involuntarily during the motion of throwing.

Outside of pitchers and people that have jobs that put high stress repetitive movement across the elbow joint, the injury is fairly uncommon and it often goes undiagnosed since performance is usually the only visible effect. There are degrees of ligament damage too, which often makes the situation even more confusing.

Sometimes the MCL (medial collateral ligament) won’t actually rupture but will instead stretch or weaken and produce symptoms similar to a full rupture. In those cases it might heal by itself, but there is always a chance that it might not. Because of that, sometimes the pitcher won’t initially know how serious the injury is. It’s very hard to diagnose and often can be missed even with an MRI or other sophisticated imaging.

In 1974 that’s exactly what happened to Tommy John. Up until that time this kind of an injury was career ending as there was no treatment, and “dead arm” was common among pitchers. It may have been the injury that almost ended the career of Satchel Paige, who went through a prolonged period of “dead arm” that finally healed. That meant that Paige, who suffered the injury before it was diagnosable, had a stretched tendon (a strain) which healed on its own.

John wasn’t so lucky. His tendon was ruptured and he asked Doctor Frank Jobe to “make up something” (to repair the tendon). They were unable to replace the ligament with a synthetic substance so they took a tendon from John’s right arm (the story that the first tendon came from a cadaver is untrue, though it has been done since) and transplanted it to replace the MCL. Typically the tendon is taken from either the forearm or the leg of the patent today.

The surgery worked and after about 18 months John returned to the Dodgers. He pitched for an additional 13 years and racked up another 164 wins. Since that day in 1974 the surgery has become a fairly common procedure among sports medicine specialists that work with ballplayers and the surgery has a very good success rate.

Typically from the time a pitcher goes under the knife it takes a minimum of 8 months to resume baseball activities. While they can get back to the majors in just about a year, that first year is statistically a rough one. Full recovery to pre-surgical strength and success usually takes 18 to 24 months.

That’s Tommy John surgery in a nutshell. If you want more specifics about the surgery itself or the anatomy please let me know and we’ll cover it in another piece.

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