It’s a well-known name among baseball fans: Tommy John. Longtime Los Angeles Dodgers fans may recognize him from his days as a star pitcher in the 1970s, but today, Tommy John is best known as a procedure pioneered by Dr. Frank Jobe.
Tommy John surgery, or ulnar collateral ligament (UCL) reconstruction, is performed on upwards of 30 major league pitchers — and many more minor league and little league players, as well as other athletes — each year in the U.S.
During the surgery, doctors remove a tendon from elsewhere in the body or from a donated cadaver to rebuild the ruptured UCL. The surgery is often required for injured high-level players who regularly throw curveballs and sliders and those who pitch several days in a row with maximum effort. However, it may also be performed in athletes such as javelin and shot-put throwers, and football players.
Major League Baseball estimates that 25 percent of major league pitchers and 15 percent of minor league pitchers will suffer a UCL injury and may need the procedure at some point in their career. Those numbers are increasing, and not just for adult athletes. A 2015 report from the American Orthopaedic Society for Sports Medicine found that nearly 60 percent of Tommy John surgeries are performed on athletes between the ages of 15 and 19, with the rate increasing 9 percent per year.
“Part of it is due to increased participation in little leagues and children getting involved at earlier ages than ever before,” says Dr. Oke Anakwenze, an orthopedic surgeon affiliated with Sharp HealthCare. Dr. Anakwenze knows about the risk-benefit analysis in treating star athletes. During his surgical training at Columbia University, he assisted team doctors for the New York Yankees and has performed research and published scientific articles about UCL reconstruction.
“There is also a bit of a misconception out there that Tommy John surgery will make you a better player than you were before the surgery, so we’re seeing an increase in parents who believe that kids may benefit from the surgery,” he says. “Like every surgery, you want to make sure you do it for the right reasons, the right indications, and everything is a risk-benefit analysis. The benefit always has to outweigh the risk.”
So, what should young athletes — and their parents and coaches — do to prevent UCL rupture?
Education is key in avoiding any preventable injury. Proper throwing techniques involve more than just the shoulder and elbow. In fact, core, trunk and back strengthening and stability are critical to safe and proper throwing and should be emphasized at the early stages of throwing.
Further, it is important to give the body a “shutdown” period occasionally, especially if the child begins to notice even minor inner elbow pain. This allows the body to heal before the damage becomes irreparable. Similarly, excessive off-season pitching exercises should be avoided.
Dr. Anakwenze offers hope for those athletes who do need Tommy John surgery. “There is a high rate of success when done for the right reasons,” he says. “The technique has evolved to the point where complications — such as damage to the nerve that travels inside the elbow, leaving people with problems in their hands and fingers — are not very common. As always, surgery should only be performed when there are no other alternatives to allow return to competition.”
For the media: To talk with Dr. Anakwenze about Tommy John surgery or other orthopedic issues, contact Erica Carlson, senior public relations specialist, at email@example.com.
This story was updated in July 2017 to clarify the percentage of youth athletes undergoing this procedure.