Tommy John Surgery

Definition

Tommy John surgery is a procedure in which a partial or fully torn ulnar collateral ligament on the medial side of the elbow is replaced with a tendon from another part of a patient's body or from a cadaver.

The procedure was first performed by Dr. Frank Jobe on Dodgers pitcher Tommy John in September 1974. Taking a tendon from John's wrist, Jobe drilled holes into John's ulna and humerus bones and grafted the tendon in a basic figure-eight design, held in place by anchors. Jobe said in 2013 that he gave the procedure "about a one in 100 chance" of working at the time. John returned to big league action in April 1976.

The second Tommy John surgery wasn't done until 1978, when pitcher Brent Strom was operated on by Jobe. Tommy John surgery has become much more common in the years since then, with at least 19 Major Leaguers undergoing the procedure in 2016 alone. The procedure has revolutionized the game, making it possible and even probable to return from an injury that previously was likely to end a career. As of June 2017, 86 percent of all players who had reportedly undergone Tommy John surgery had at the very least returned to the competition level they were at prior to the procedure. For example, a Triple-A pitcher who had Tommy John surgery and subsequently made it back to Triple-A or appeared in the Majors would count toward the 86 percent of successful cases.

Typical recovery time

Pitchers who have undergone Tommy John surgery are usually given a recovery timetable of 12 to 18 months. The recovery time is much less certain for those undergoing the procedure for a second time, though fewer than 90 players are known to have had the surgery more than once, as of August 2017.

A experimental procedure known as "primary repair" has emerged as a potential alternative to Tommy John surgery, offering a shorter recovery time. The procedure uses a technique, pioneered by Dr. Gordon Mackay, in which a product called SutureTape is attached to two screws inserted into the bones at each end of a ligament or tendon, providing a framework against which the ligament or tendon can heal. Because the SutureTape is porous, the damaged ligament or tendon grows through the lattice of the SutureTape and is supported by it. Seth Maness underwent the "primary repair" procedure on his elbow in August 2016 and returned to the Majors by May 2017.