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When pitchers tore their ulnar collateral ligaments prior to 1974, they became former pitchers. But Dr. Frank Jobe changed that when he performed ligament-replacement surgery on former Major League pitcher Tommy John.
Now, pitchers are back on the mound within a year of having the surgery. Some come back stronger, some struggle. According to a Sporting News study, more than 150 current Major League players have had the operation.
“I would never have thought it would happen,” Jobe told The Washington Post. “It’s been a very fortunate experience for me. It just turned out very well.”
Ulnar collateral ligament reconstruction, commonly known as Tommy John surgery, is a surgical procedure to reconstruct the UCL using a tendon from the forearm. The tendon is used to recreate the damaged ligament and improve the stability of the elbow joint.
A tendon is removed from the patient’s wrist and grafted into the elbow — woven in a figure-eight pattern through tunnels drilled in the humerus and ulna bones. Doctors typically complete the operation in about an hour.
The procedure is similar to that done for reconstructive surgery of the anterior cruciate knee ligament (ACL) that has revived the careers of many football and basketball players.
“I call it the anterior cruciate (surgery) of the elbow,” Dr. James Andrews, the renowned Birmingham, Ala., orthopedic surgeon, told USA Today.
Hardin County has seen its fair share of Tommy John surgeries. Seattle Mariners pitcher Stevie Delabar, a former Central Hardin standout, had the procedure in college. Nick Smith and Hunter Catron each had the surgery in high school. This year, two players – LaRue County senior Jesse Johnson and Elizabethtown junior Garrett Morgan – are back after needing the surgery in the last 13 months.
Dr. Michael Krueger of Hardin Orthopedics & Sports Medicine in Elizabethtown estimates he has performed five to six Tommy John surgeries in the last year. He said he doesn’t know if that’s a lot or a little.
“With Tommy John surgery, more than 90 percent of the players come back,” Krueger said. “Through the season, players gradually get more and more confidence. Within one or two seasons, they are fully back.”
The UCL is the ligament that creates the stability which allows the high-stress action of throwing a baseball. Athletes are especially prone to tear the ligament because it becomes more frayed after heavier than normal wear and tear, especially through repetitive motion. In the case of a pitcher, the action of throwing overhand can prove incredibly hard to maintain on a deteriorating UCL.
The surgery requires a full year of rehabilitation and typically another year pitching before returning to pre-injury form. Essentially, the body must convert a tendon into a ligament, get it carrying blood again and train it to start working as a ligament. A ligament connects bones, stabilizing a joint. A tendon attaches muscle to the bone. It is very weak immediately after the surgery, and the rebuilding process must be gradual.
Krueger said the elbow needs to be braced for typically six weeks. But the patient begins what he described as protective therapy within a week of surgery. The rehabilitation process is a gradual one. There is no bicep or triceps work done at first as the process focuses on flexibility and working on the core.
Players start a light-tossing program at four months, but they don’t begin pitching until nine months and they usually don’t step on a mound again until usually 12 months, according to Krueger.
Although it’s a lengthy process, players typically recover and go on to enjoy long careers. Delabar is one example. Smith played at Campbellsville University, while Johnson and Morgan both are full-time players again this year. Johnson has even returned to the mound.
“Players have to learn how to throw again,” Krueger said. “The single thing is players learn good pitching mechanics. They unlearn bad habits and now they start off with good mechanics. The arm and shoulder is more flexible. They have improved flexibility is the second thing. And third is keeping the core strong.”
Krueger said the key for pitchers is taking care of their arms the proper way, especially prior to and after pitching.
“Icing should be a part of pitching,” Krueger said. “If they are sore, they need to ice it. There was a study done that said players with a sore shoulder or elbow are 900 times at an increased risk of tearing something. Pitching through pain is not a good thing. Stretching after a game is more important than stretching before it. Pitchers need to be smart and make sure they’re doing the right things.”
Chuck Jones can be reached at (270) 505-1759 or at firstname.lastname@example.org