Tommy John was an extremely successful Major League pitcher whose career spanned from 1963 to 1989. He was a four-time MLB All Star; and among baseball’s all-time leaders, he is 8th in games started and 26th in both wins and shutouts.
Yet after his stats and awards are eclipsed and forgotten, his name will live on because of what happened to his pitching elbow and the treatment he received. It changed the entire game. To my knowledge, Tommy John is the only patient to have a surgical procedure named after him—a form of immortality, I suppose, at least in the baseball world. (Another baseball great, Lou Gehrig, famously developed a deadly disease, which carries his name.)
About 11 years into John’s Major League career, John ripped his elbow’s supporting (collateral) ligament on the side closest to his trunk. This is the ”ulnar side” in ortho speak. He said that it felt like his throwing arm was flying out over second base as the rest of his body continued its momentum toward the plate.
After a month of rest and rehab, he still couldn’t pitch effectively and so underwent an entirely untested ulnar collateral ligament reconstruction. His surgeon gave him a one-in-a-hundred chance that he would ever pitch again. Those were terrible odds, but the only alternative was to quit baseball.
His surgeon took a tendon from John’s opposite forearm, the one that 15% of people are naturally missing. The surgeon drilled bone holes on both sides of John’s elbow and laced the graft in figure-of-eight fashion to substitute for the failed ligament. John rehabbed for over a year and then returned to the Dodger’s starting lineup and pitched multiple shutouts and 20-game winning seasons over the rest of his career.
Aware of the success of John’s surgery, pitchers started gripping the ball tighter to make it spin faster and throwing harder over more innings with fewer rest days. They knew that if they tore their elbow ligament, they could have the “Tommy John procedure.” For MLB pitchers active in 2023, over a third of them had received this procedure at some time in their career. Some experts speculate that the recently instituted pitch clock, designed to speed up a baseball game, allows less recovery between pitches and contributes to the problem. If so, we are going to see more elbow injuries.
These are not sudden injuries to strong, healthy ligaments like what can happen to ones in fingers and ankles. Rather they are wear-and-tear issues that finally surface with a pop, like ACL tears. And they are not restricted solely to the pros.
Little Leaguers and high school pitchers are playing year-round; and naturally they emulate the Major Leaguers by trying to put more spin and more heat on their throws. For training, weighted baseballs ranging up to 70 ounces (half the weight of a woman’s shot put) are readily available on the internet, whereas a regulation baseball weights about five ounces. Additionally, dads may be behind home plate with radar guns hoping that a future Major League contract will put the whole family on easy street. Finally, the progressively overwhelmed ligament snaps. On examination, the joint may not gap open perceptibly when moderately stressed by an examiner, but it apparently opens up sufficiently while accelerating a baseball to 90 or 100 miles an hour to cause pain and momentary instability.
After a year of rehab, the surgery returns most pitchers to the mound, but some hurlers reinjure their elbow and require a second operation. There are even several who have had three reconstructions. At some point, they will run out of donor tendons to use for graft material. In anticipation of such a shortage, some surgeons are now reinforcing the reconstructions with strong, nonabsorbable suture material. As with other ligament reconstructions, doing so makes the reconstruction stronger early after surgery, but it may shield the transferred cells from performing at their best and strengthening the stabilization on their own. Time will tell.
Can you imagine that if this trend continues, a baseball rule change would be in order? “Any pitch over 88 MPH is called a ball whether or not it is in the strike zone.” It could be called the Tommy John rule.
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