Tommy John Surgery: Is There an Epidemic?

Ulnar collateral ligament (UCL) reconstruction—or the Tommy John procedure as it’s known to sports fans—has come a long way since its invention in 1974. It’s not only a more refined procedure today, it’s more popular.

In 2000, 13 Major League Baseball pitchers underwent UCL reconstruction. In 2012, almost 3 times as many Major League Baseball pitchers had Tommy John Surgery and they tended to be younger. In fact, surgeons perform more and more UCLs on high school students. An editorial in the January 2015 issue of The American Journal of Orthopedics asks if orthopedic surgeons have a role in what the author considers an epidemic, placing the patient’s health above the coach’s (or the patient’s) beliefs?

The author, a Sports Medicine Resident, at Rush University Medical Center, Chicago, IL, presents a compelling description of Tommy John surgery through the years. He covers sabermetrics, which evaluate the pitcher’s effectiveness, showing sabermetrics tend to improve after UCL reconstruction and explaining some factors responsible for the change. He stresses the seriousness of surgery and rehabilitation, and the need for surgeons to ensure that patients understand that their personal resources are probably significantly less than those available to Major League Baseball pitchers.

A significant point concerns parents who must consent for their underage children. They may be under the disillusion that UCL reconstruction will improve their children’s throwing speed, distance or accuracy. It will not. The author highlights survey findings that indicate the younger the potential patient, the more likely patients and parents are to have wildly unrealistic expectations. He stresses that surgery should not be a first option, and warns that prophylactic use of UCL reconstruction is irresponsible.

Additionally, the editorial alerts readers that technology is advancing, and may help prevent UCL problems. A compression sleeve with imbedded sensors is in development and will be commercially available soon. It will track elbow biomechanics and joint wear cumulatively, and should warn coaches when pitchers’ elbows begin to fatigue.