Is surgery changing baseball?

Tommy John Surgery

Lee Dempsey/

­The opening credits for the classic TV sho­w "The Six Million Dollar Man" echo much of the optimism of medical science. "Gentlemen, we can rebuild him," the voice-over says. "We have the technology. We have the capacity to build the world's first bionic man." The hour-long adventure series hit the airwaves in 1974, the same year Los Angeles Dodgers pitcher Tommy John allowed surgeons to perform a radical new procedure on his ruined elbow.

Created by orthopedic surgeon Dr. Frank Jobe, the procedure that we now know as Tommy John surgery has since become commonplace among big league players -- especially pitchers. Whether you're throwing a baseball or a javelin, you put a great deal of stress on the elbow. Keep it up and the repetitious strain can lead to inflammation, microscopic tissue trauma and ultimately a tear in the ulnar collateral ligament (UCL), also known as the medial collateral ligament (MCL).


In the past, such an injury would spell the end of a career. While the hurt player would still be able to perform day-to-day movements, he would never again be able to throw with significant force or speed.

The Tommy John procedure follows a basic design. Imagine you have two boots and the lace on one breaks beyond your ability to repair it. The lace on your other boot, however, is in great condition and has plenty of length. Why not simply cut some excess lace from one boot and use it to mend the other? Surgeons do much the same thing to a UCL tear. They take a tendon from the patient's forearm or hamstring and graft it into the elbow to replace the torn ligament. Of course, there are no holes for the "laces," so the surgeon first drills a series of holes into the arm's ulna and humerus bones. After these holes are completed, the tendon is weaved ­into a figure eight pattern through the holes.

Sound simple? Well, the surgery is far from a quick fix. Recipients face a year of strenuous rehabilitation before they can return to action. Moreover, the operation presents its share of risks. The surgeon has to detach major muscles and move the ulnar nerve out of the way, all of which can result in infection, fracture, nerve irritation and numbness. When Tommy John himself received the procedure, the odds of recovery were 1 in 100 [source: Fraser]. Today, around 83 percent of the operations go as planned [source: Altman].