Tommy John surgery

Tommy John surgery, known by doctors as ulnar collateral ligament reconstruction (or UCL), 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 players in several sports, most notably baseball.

The surgery is named after Tommy John, a pitcher for the Los Angeles Dodgers who was the first professional athlete to successfully undergo the operation in 1974. The procedure was performed by Dr. Frank Jobe.

Process

After the tendon from the forearm of the opposite elbow or below the knee is harvested it is then woven in a figure-eight pattern through tunnels that have been drilled in the ulna and humerus bone that are part of the elbow joint.

There is a risk of damage to the ulnar nerve.cite journal |author=Purcell DB, Matava MJ, Wright RW |title=Ulnar collateral ligament reconstruction: a systematic review |journal=Clin. Orthop. Relat. Res. |volume=455 |issue= |pages=72–7 |year=2007 |pmid=17279038 |doi=10.1097/BLO.0b013e31802eb447]

Recovery

Chances of a complete recovery after surgery are estimated today at 85 to 90 percent. At the time of Tommy John's operation, Jobe 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. Today, the procedure takes about an hour. Full rehabilitation takes about a 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 start doing weight exercises. For the next four months, they can increase the weight that they use and start doing exercises that emphasize all parts of their arm.

Risk Factors

The ulnar collateral ligament can become stretched, frayed, or torn through the reptitive stress of the throwing motion. The risk of injury to the throwing athlete's UCL of the elbow is thought to be extremely high as the amount of stress through this structure approaches its ultimate tensile strength during each and every hard throw [Fleisig, G.S., The biomechanics of baseball pitching, in Biomechanical Engineering. 1994, University of Alabama: Birmingham. p. 163.] .

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 [Lyman, S., et al., Effect of pitch type, pitch count, and pitching mechanics on risk of elbow and shoulder pain in youth baseball pitchers. Am J Sports Med, 2002. 30(4): p. 463-8.] . The 2002 study followed 426 pitchers aged 9 to 14 for one year, and studied their throwing volume, pitch type, and throwing mechanics. Compared to pitchers who threw 200 or fewer pitches in a season, players 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 curve ball was associated with an increase in shoulder pain. There was only a weak correlation between throwing mechanics perceived as bad and injury. Thus, although there is a large body of other evidence that suggests mistakes in throwing mechanics increase the likelihood of injury [Whiteley, R., Baseball throwing mechanics as they relate to pathology and performance - a review. Journal of Sports Science & Medicine, 2007. 6(1): p. 1-20.] 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 [Lyman, S., et al., Longitudinal study of elbow and shoulder pain in youth baseball pitchers. Med Sci Sports Exerc, 2001. 33(11): p. 1803-10.] .

In younger athletes for whom the growth plate (the medial epicondylar physis) is still present, the "opening up" force at the inside of the elbow during throwing is more likely to fail at this region than at the Ulnar Collateral Ligament. This injury is often termed "Little League Elbow," and does not require reconstructing the Ulnar Collateral Ligament.

Frequency

Today, the surgery is becoming more common in children 10-18 years old due to increased season length, the rise of travel teams (and tournament play), and the more frequent use of breaking pitches by young pitchers.

Misconceptions

In some cases baseball pitchers throw harder after the procedure than they did beforehand. As a result, orthopedic surgeons like Dr. James Andrews are reporting 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 degrade. 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 that he could before their UCL started to degrade [Keri, Jonah, Interview With Frank Jobe. http://espn.go.com/mlb/columns/bp/1431308.html] .

List of baseball players receiving the surgery

All are pitchers unless otherwise noted.
*Brian Anderson
*Rick Ankiel (converted to outfielder)
*Andy Ashby
*Luis Ayala
*Brandon Backe
*Danys Baez
*Rocco Baldelli (outfielder)
*Rod Beck
*Erik Bedard
*Francis Beltran
*Jeff Bennett
*Kris Benson
*Adam Bernero
*Brent Billingsley
*Joe Borchard (outfielder)
*Dewon Brazelton
*Ambiorix Burgos
*A. J. Burnett
*Paul Byrd
*Jorge Campillo
*José Canseco (outfielder; injured while pitching)
*Chris Capuano (twice)
*Chris Carpenter
*Rocky Cherry
*Shin-Soo Choo (outfielder)
*Todd Coffey
*Manny Delcarmen
*Ryan Dempster
*Chris Denorfia (outfielder)
*Jorge DePaula
*Brendan Donnelly
*Octavio Dotel
*Phil Dumatrait
*Adam Eaton
*Dave Eiland (twice)
*Willie Eyre
*Jesse Foppert
*Chad Fox (three times)
*John Franco
*Frank Francisco
*Eric Gagné
*Rusty Greer (outfielder)
*Luis Gonzalez (outfielder)
* Mike Gonzalez
*Lee Gronkiewicz
*Angel Guzman
*Mike Hampton
*Pat Hentgen
*Runelvys Hernández
*Shawn Hill
*Matt Holliday (outfielder)
*Norris Hopper (outfielder)
*Tim Hudson
*Philip Humber
*César Izturis (infielder)
*Jason Isringhausen
*Tommy John
*Kelly Johnson (infielder)
*Josh Johnson
*Steve Karsay
*Jimmy Key
*Josh Kinney
*Hong-Chih Kuo (twice)
*Cory Lidle
*Jon Lieber
*Mike Lincoln (twice)
*Francisco Liriano
*Matt Mantei
*Shaun Marcum
*Scott Mathieson (twice)
*Joe Mays
*Seth McClung
*Dustin McGowan
*Matt Morris
*Peter Moylan
*Xavier Nady (outfielder)
*Russ Ortiz
*Juan Padilla
*John Parrish
*Carl Pavano
*Chris Ray
*Carlos Quentin (outfielder)
*Britt Reames
*Arthur Rhodes
*Matt Riley (three times)
*Ricardo Rincón
*Mariano Rivera
*Fernando Rodney
*Kenny Rogers
*Francisco Rosario
*B. J. Ryan
*Aníbal Sánchez
*Jose Rijo (three times)
*Humberto Sánchez
*Scott Schoeneweis
*Jae Seo
*John Smoltz
*Kyle Snyder
*Joakim Soria
*Rafael Soriano
*Tim Spooneybarger
*Clete Thomas (outfielder)
*Merkin Valdez
*Billy Wagner
*Tyler Walker
*Travis Webb
*Jake Westbrook
*Scott Williamson
*Brian Wilson
*Vance Wilson (twice)(catcher)
*Mark Wohlers
*Randy Wolf
*Kerry Wood
*Jaret Wright
*Tyler Yates
*Matt Young
*Mike Zagurski
*Víctor Zambrano (twice)
*Jeff Zimmerman (twice)

List of football players receiving the surgery

*Jake Delhomme
*Craig Erickson
*Chris Hunter
*Sebastian Janikowski (did not affect his career, as he is a placekicker)
*Rob Johnson

References

External links

* [http://www.usatoday.com/sports/baseball/2003-07-28-cover-tommy-john_x.htm USA Today article]
* [http://www.ocfamily.com/archives/ocfamily_2005/ocfamily0205/game_0205.html OC Family Magazine article on avoiding Tommy John injury in young pitchers]
* [http://www.asmi.org/asmiweb/usabaseball.htm Research-based pitch limit suggestions according to the age of the pitcher]