Tommy John FAQ: Dr. Andrews answers frequent questions related to Tommy John surgery

Tommy John FAQ

What is Tommy John surgery?

Tommy John surgery is a ligament surgery in the elbow. It is named after the first baseball pitcher, Tommy John, who had this surgery performed in 1974. When a baseball player throws a baseball overhand the elbow is stretched and torqued. There is a ligament on the inside of the elbow (also called the medial side or the ulnar side) that connects the lower arm bone (the ulna) to the upper arm bone (the humerus). This ligament is called the ulnar collateral ligament (often abbreviated UCL), the medial collateral ligament or the tommy john ligament. If the force generated when throwing the baseball is greater than the ligament can withstand, the ligament can tear. Once the ligament is torn, it can be difficult to pitch with the same velocity and accuracy without experiencing pain or numbness. If the ligament is torn directly from the bone and is otherwise healthy, it may be repairable. If the ligament is torn in the middle or too damaged to be repaired, it can be rebuilt with a tendon graft that is often taken from the forearm (palmaris) or the leg (hamstring). This surgery is called an ulnar collateral ligament reconstruction (abbreviated UCLR), but is also commonly known as Tommy John surgery.

What other options besides surgery are available for Tommy John injury?

Depending upon the degree of damage to the ligament, it may be possible to return to play without surgery. Non-surgical treatment for Tommy John injury includes rest from throwing, specific exercises to strengthen the muscles and tendons that help to stabilize the elbow, and potentially injections. The most common injections for Tommy John injuries are platelet-rich plasma (often abbreviated PRP) and stem cell injections. Platelet-rich plasma is created when a doctor draws a patient’s blood and concentrates the platelets and plasma from the patient’s red blood cells. This concentrate contains growth-factors. Stem cells are usually taken from bone marrow using a needle placed into the bone. These stem cells can then be reinjected into the damaged area of the ligament. After receiving an injection, your doctor may recommend a brace or a repeat injection. It can take 3-6 months to return to pitching with non-operative treatment.

Does an athlete require an actual elbow injury to undergo Tommy John surgery?

Yes, baseball players should only undergo Tommy John surgery if they have a ligament tear. This surgery does not improve velocity or performance or protect against future injury, and thus it is only recommended if necessary to continue playing. This surgery should never, under any circumstance, be done prophylactically (meaning to prevent an injury to the ligament).

How many pitchers undergo Tommy John surgery per year?

While it is unclear what the total number of Tommy John surgeries is in the United States as a whole, in Major League Baseball alone, there have been ~30 players who undergo Tommy John surgery for ulnar collateral ligament tears each year for at least the past 10 years. A 2018 survey of active players found that 26 percent of Major League pitchers and 19 percent of Minor League pitchers had undergone Tommy John surgery at some point in their careers. While the total number of Tommy John surgeries per year in adolescent pitchers is unknown, the rate of increase in the number of Tommy John surgeries each year in players aged 15-19 years has been over 9% per year.

How often are pitchers able to return to play baseball after Tommy John surgery?

Pitchers are able to return to baseball >70-80% of the time after Tommy John surgery. While the surgery is generally considered successful in most cases, it does not always succeed and is not a guarantee of a return to play at the same level.

How long does it take to return to competitive throwing following surgery?

The length of return to competition following surgery is dependent upon many factors. For instance, an infielder who undergoes an ulnar collateral ligament repair may return to competition as early as 5-6 months, while a starting pitcher who undergoes an ulnar collateral ligament reconstruction may not return to pitching 6-7 innings until 18 months or more after surgery. Many players return to batting before they can return to fielding.

Are pitchers having the surgery at a younger age?

Yes. More and more young pitchers are undergoing Tommy John surgery and many surgeons have described an “epidemic” of youth and adolescent players with Tommy John ligament tears. Preventing these injuries before they happen is one of the main purposes of the Pitch Smart program. Following the recommendations within the Pitch Smart program can help prevent injury.

Does Tommy John surgery improve performance or pitching velocity or prevent future injuries?

Tommy John surgery does not improve velocity or performance or protect against future injury, and thus it is only recommended if necessary to continue playing. This surgery should never be performed in an attempt to improve performance.

How often do pitchers suffer another arm injury after having Tommy John surgery?

Suffering another arm injury after having Tommy John Surgery is common. In one study within Major League Baseball, 28-37% of pitchers who underwent Tommy John surgery had another injury to their arm later in their career.

Can someone have Tommy John surgery twice?

Yes, it is possible to tear the ligament again after surgery and have to have a re-do ligament reconstruction. The results following a repeat Tommy John surgery are not as reliable as the results from the first Tommy John surgery.