Tommy John Surgery: the meat of the matter

Like many pitchers before him, Sandy Koufax retired early because his pitching arm was ravaged by the unnatural act of throwing a baseball incredibly fast, sometimes throwing it with a seemingly impossible curve. The stress on his ulnar collateral ligament was too much to bear. It was a great shame.

            “If I was smart enough to do this 10 years before, it might be called Koufax surgery,” said Dr. Frank Jobe, who died this year (2014).

            Jobe performed what turned out to be successful elbow surgery on Tommy John in 1974, forever changing the outlook for future generations of pitchers. The procedure, though grisly, seems fairly simple (with the added advantage that it actually works). A tendon is harvested from elsewhere in the patient’s body (other elbow or knee) and then transplanted into the wounded elbow. Sometimes a tendon from a cadaver is used. The new tendon is attached to the ulna and humerus bones in the damaged elbow. After a year or so of recovery, a pitcher can start to regain his former velocity. The success rate these days is fairly high.

            Most professional pitchers eventually need some kind of arm surgery to prolong their careers. Throwing a baseball at high torque, repeatedly, causes all kinds of problems. But some pitchers are freaks of nature. They go an entire career without a serious arm injury. The biggest freak of nature in MLB has to be R.A. Dickey, who was born without an ulnar collateral ligament and pitched/is pitching past age 40 as a knuckleballer. Talk about a new market efficiency. Maybe parents should have promising youngsters go under the knife early and decisively, removing all doubt about potential elbow problems? (Caution: this probably wouldn’t work out well.)

            In addition to the elbow, there is another big area of concern for pitchers. If faster advances in rotator cuff surgery (and rehabilitation) would have been made in the 1970s, Steve Busby might have thrown more than two no-hitters for Kansas City – he was the first pitcher with two no-hitters in his first two seasons. Busby’s very brief but stellar career was effectively over in 1976 after he blew out his shoulder. He was the first pitcher to try to make a comeback from rotator cuff surgery, but the operation didn’t take.

            A pitcher is said to have blown out his shoulder because it can be a mess of muscles and tendons in there. Some shoulder surgeries are done arthroscopically while others require long incisions. The idea is to repair torn tendons through sutures and/or anchors. The amount of damage and therefore the degree of invasiveness required to fix it varies. Rotator cuff procedures are common, but strenuous rehabilitation efforts are necessary for pitchers who want to continue professional careers.

            Thus far, nobody (that I know of) has ever been born without a rotator cuff, which is really more of a region in the shoulder than a thing. (Talk about limber.) But plenty of pitchers have made full comebacks from these surgeries in the post-Carter years.

P.S. Prior to the 1970s, the only way for pitchers to continue their careers after experiencing serious elbow or shoulder damage was to re-invent themselves almost exclusively (and painfully) as a knuckleballer.