Dr. M: Nuts and bolts of Tommy John surgery


By Dr. Neil Minkoff

It looks as though Daisuke Matsuzaka and Rich Hill may undergo Tommy John surgery to repair their shredded elbows.

We hear about Tommy John surgery all the time, but what exactly is it?

In 1974, Dodgers pitcher Tommy John was having a career year with a record of 13-3 when he got news that should have ended his career. He was told that his ulnar collateral ligament in the elbow of his pitching arm was torn. John had blown out his elbow. Nobody in the history of baseball had ever pitched effectively after getting this news.

Johns career continued because Dr. Frank Jobe developed what surgeons call Ulnar Collateral Ligament Reconstruction. You know it as Tommy John surgery. Being the first patient to have it done has made John as immortal in baseball as if he had been named to the Hall of Fame.

What is an ulnar collateral ligament? And why does it need surgery?
The UCL is a triangle of three bands that holds the inner side of your elbow together.

The only real way to damage it is to be a pitcher. Hurling a ball with reasonable accuracy at speeds near 100 mph is an incredibly unnatural act for the human body. After tens of thousands of pitches, the UCL wears down, frays and splits, causing pain and weakness. When it does, theres literally nothing holding the bones together.

Jobe found a replacement for the torn ligament in 1974. Since then, the procedure has been refined somewhat, but here are the basics:

The surgeon cuts over the side of the elbow closer to the chest and pushes the surrounding muscle aside to reveal the bones involvedthe ulna and the humerus. Holes are drilled through both bones. A tendon is then threaded through the holes in both bones. This is done to improve the strength of the repair. The tendon is much weaker than the ligament its replacing.

The most important part of the procedure is to lace the bones together in a way that is strong enough for the patient to be able to pitch without being too tight.

It takes a year to properly rehab, because the tendon is so much weaker than the ligament it replaced. The biggest danger is that young pitchers feel so much better, they put too much strain on the joint. A pitcher should use this time to strengthen his shoulder so he can pitch after the tendon heals in place.

Tommy John surgery is successful about 90 percent of the time.

What happened to Tommy John?
After missing the 1975 season to rehab his newly repaired elbow, he pitched for another 14 seasons, retiring at age 46 from the Yankees. He made the All-Star team three times after the surgery during the 1978-80 seasons. He went 2-1 in his career in the World Series. His lifetime ERA is a respectable 3.34 and he finished up with 288 lifetime wins, 164 of which came after his operation.

Contact Us