Conte: Tommy John surgery misconceptions common

Stan Conte reads scholarly orthopedic journals so the rest of us don't have to. And the Dodgers' vice president of medical services is doing what he can to assure that more accurate information about Tommy John surgery reaches a mainstream audience.

One particular study jumped out during Conte's research.

"Thirty-one percent of coaches and 37 percent of parents thought it was OK to do a Tommy John surgery just to improve performance even though they didn't have an elbow injury," Conte recalled. "I was shocked by the number of parents who would put their kids through a surgery to get them to perform better, not because they were injured. I kept thinking about that, how crazy that is."

That was especially disturbing to Conte because he knew studies by Dr. Chris Ahmad of the Yankees and Dr. Anthony Romeo of the White Sox had demonstrated that the idea that pitchers throw harder after undergoing the ulnar collateral ligament (UCL) reconstruction pioneered by Dr. Frank Jobe four decades ago simply isn't true.

It's also wrong to believe that pitchers will return to the mound in 12 months or that the operation is 100-percent successful, though these are commonly reported as facts, too.

"This is not a thing that's trying to pull down Tommy John surgery as not a good surgery. It's an unbelievably successful surgery. It's a lifesaver for pitchers," Conte stressed. "You just have to walk into it with both eyes open, that's all. No operation is 100 percent successful. But there has been this idea that somehow it is and you come back throwing harder and faster and can leap tall buildings in a single bound and all that kind of stuff."

Reasoning that public perceptions are influenced by the media, Conte sent out 30-question surveys to 1,100 reporters to gauge their knowledge of the operation, and he received 516 responses. The results closely tracked Ahmad's study of the public.

"As far doing Tommy John to improve performance, and whether or not you had to have an elbow injury to improve it, it was very similar to the public perception." Conte said. "The biggest thing was 45 percent either said you didn't need an elbow injury to get that or didn't know whether you needed an elbow injury. Twenty-five percent thought it was OK to do it to improve performance."

Conte elaborated on the three major misconceptions.

• First, that pitchers throw harder after having Tommy John surgery.

"You don't walk in throwing, 91 [mph] and come out throwing 93," Conte said. "You just don't. And that's been shown through two different studies."

"They actually decline a little bit in velocity. But when you use age-adjusted [analytics], because it's usually a couple years before they come back, they're at about the same level as they would have been if they hadn't been injured."

• Second, that pitchers can be expected to return in 12 months.

"So there's a lot of pressure on medical people to get these people back," Conte said. "But there are two studies [by Dr. Ahmad and Dr. Romeo] that showed that 16.7 months or over 20 months is the average."

That number could be skewed by one pitcher being out, say, three years. The median measures the midpoint between all the pitchers above and all below. By that method, the "normal" time it takes to return is 14 months.

"Now, why do we care, 12 months or 14 months or whatever?" Conte asked rhetorically. "If the player thinks it should be 12 months and he doesn't make it back in that time, he thinks he's a failure. And it trickles down to a lot of different levels. The general managers will say, "Why isn't he ready in 12 months?' Well, the stats show that they don't and there's a range of these guys, and really it's about 14 to 18 months.

"So the expectations of the public, the fans, the media, the front office and the player are not in line with what actually happens."

(Conte noted that last year 11 big league pitchers underwent second Tommy John surgeries. While no consensus has been reached on why, one obvious possibility is that they didn't rehab long enough.)

• Finally, that Tommy John surgery is always successful.

Two studies, again done by Dr, Ahmad and Dr. Romeo, indicate that 83 percent of big leaguers who have the operation come back to pitch at least one game in the Majors and 67 percent pitch in at least 10 games. Which is still an impressive number, even if not as high as most people believe.

For Conte, the bottom line is that baseball and medical people have to do a better job of educating the media to separate the myths from the realities when it comes to Tommy John surgery.