Tommy John Case

Tommy John Surgery

For most of us we have either heard who Tommy John is or we have no idea. For those who have no clue, Tommy John is one of baseball's most famous players, but it is not because of a record that he broke or because he has several World Series rings on his hand. Tommy John is one of baseball's most famous players because of an advanced surgery that he received and after the results proved so beneficial, it was named after him. Tommy John was one of the first baseball players to receive medial ulnar collateral ligament (UCL) reconstruction, after he permanently damaged his ligament during the 1974 season (Gibson, Webner, Huffman, & Sennett, 2007). This is now referred to as Tommy John surgery. Since then several pitchers have chosen to receive the same surgery, and to no surprise have successfully returned to baseball, competing at the same or higher level of performance as before. John Smoltz, Mariano Rivera, and Eric Gagne have all received the treatment and have all returned to baseball and finished out great careers (Carroll & Gorman 2004). Will someone who has the surgery be able to return and compete at the same level after taking the time off? And is the surgery worth the risk? Recent studies show that the answer to both of these questions is yes.

Throwing a baseball causes severe stress on the medial ulnar collateral ligament. Baseball players can damage the ligament from overuse. It is reported that the ultimate tensile strength in resisting valgus torque of the medial UCL is 33 Newton meters (N*m), while the torque on the ligament while pitching a baseball has been estimated at 32 N*m (Rohrbough, Altcheck, Hyman, Williams III, & Botts, 2002). Since this ligament plays a major role in the stabilization of the joint, repeated stress can cause the ligament to rupture or tear loose from its attachment to the bone. This may cause a reduction in throwing velocity and accuracy (Jobe, Stark, & Lombardo, 1986).

In Tommy John's case, he pitched part of the 1974 season without trouble until he threw a hard slider and felt his elbow give way. He was unable to pitch due to pain, lack of accuracy and reduced velocity. Tests later confirmed that he had ruptured his medial UCL. He was operated on in September of 1974 by Dr. Frank Jobe and his colleagues, who had developed the procedure (Jobe et al., 1986).

Tommy John was part of a study done by Dr. Jobe and his colleagues beginning in 1974 involving sixteen throwing athletes. They included twelve professional baseball pitchers, one college pitcher, one major league center fielder, and two javelin throwers. In almost all of the athletes with whom Dr. Jobe worked, they experienced pain in the medial portion of the elbow involved with throwing for an extended period of time prior to the surgery (Jobe et al., 1986). Many of the athletes were reluctant to receive the surgery, because they were afraid that they might not pitch again competitively after an elbow operation. However, alternative methods to surgery including rest, application of heat and ice, anti-inflammatory medication, and exercises were ineffective (Jobe et al., 1986).

The surgery, as described by Jobe, involved opening the elbow on medial side of the arm and making a longitudinal split in the flexor muscles to expose the anterior portion of the UCL. The ulnar nerve was moved anterior to the medial epicondyle to provide better access to the ligament. Then they used a drill to make a hole at the attachment points of the ligament, the medial epicondyle and the ulna. This was done to prevent the new tendon graft from rubbing on the epicondyle (Jobe et al., 1986).

In twelve patients, including Tommy John, the palmaris longus tendon was used as the graft. In three patients the plantaris was used, and in one a portion of the Achilles tendon was used. The tendon graft was passed through the drilled holes and looped into a figure eight. Then it was pulled tight and sutured

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