In the modern era of sports medicine where Tommy John surgery is a household name and more than 2,200 Major League Baseball players have had the procedure — it can be easy to forget that before Frank Jobe, MD, pioneered it in 1974, ruptured Ulnar Collateral Ligament (UCL) —an elbow injury—often meant the end of a baseball career.
“There is no question that when it comes to earning potential and return to play, Tommy John is the most valuable reconstructive procedure there is for athletes,” said Neal ElAttrache, MD (Los Angeles, CA), head team physician for the Los Angeles Dodgers, who learned the procedure from Dr. Jobe. “Careers have been saved; careers have been lengthened. Younger players are able to continue developing as baseball players. The procedure has allowed some of our greatest athletes to continue performing at the highest level.”
Tommy John himself went on to pitch for another 15 years, and in 2013, Dr. Jobe was honored by the National Baseball Hall of Fame in Cooperstown, New York, for his contribution to the game.
But when Dr. Jobe and Robert K. Kerlan, MD, established the Kerlan-Jobe orthopedic fellowship in 1973, sports medicine was not even recognized as a medical specialty. Today, the Kerlan-Jobe Institute is one of the longest running sports medicine fellowships the country.
“Clearly Dr. Jobe was one of the founders of the field of sports medicine, due to this surgery,” said Joshua Dines, MD (New York), former team physician for the New York Rangers and the New York Mets. “Ninety-nine percent of the time, you’re performing this operation to return a serious athlete to their sport. The elbow is inherently stable, and many people can live with a UCL tear unless they need that overhead throwing motion for a sport like baseball or throwing the javelin.”
James Bradley, MD (Pittsburgh), head team orthopedic surgeon for the Pittsburgh Steelers for more than 30 years, was the first surgeon from Pittsburgh admitted to the fellowship at Kerlan-Jobe. He says learning the procedure from the master himself helped launch his career, in addition to saving those of many professional athletes — including some football players.
“Dr. Jobe was a magician as a surgeon…a true virtuoso in the operating room,” Dr. Bradley said. “People got to know me because I could scope shoulders and do Tommy Johns, which no one in my area could do. I was very lucky to be there when Dr. Jobe had perfected the surgery, learning when to move the ulnar nerve and when not to.”
Arthrex was on the forefront of helping Tommy John surgery to evolve and improve outcomes, said Arthrex Senior Product Manager Allen Holowecky.
“Traditionally, surgeons drilled tunnels freehand. Arthrex collaborated with key opinion leaders to develop a guide system and instrumentation to help make the Tommy John procedure more repeatable and efficient.”
With the development of new anchor technologies and suture tape reinforcement, primary repair of the UCL is becoming a popular and effective treatment option. In some cases, surgeons now repair the UCL, rather than replacing it, and then add the UCL InternalBrace™ system to augment the repair. In other cases, surgeons perform a hybrid operation, replacing the ligament and then augmenting it with the InternalBrace procedure. ¹-³
“If a patient needs a reconstruction, they are getting a reconstruction, but in some cases, if the UCL is tacked down, it will heal,” said Allen. “The InternalBrace system has given patients the ability to return to sport more quickly, under the right circumstances.4-6 We believe the future of Tommy John surgery is likely a hybrid procedure combining the reconstruction with an InternalBrace.”
It is a perfect example, Allen says, of the Arthrex mission of Helping Surgeon Treat Their Patients Better®.
“Today, we have more tricks in our bag, and a bigger bag to draw from,” Dr. Bradley said. “And that leads to better outcomes.”
Dr. ElAttrache says that the Tommy John procedure has almost become a rite of passage for professional baseball players. The results are so trusted that his patient Shohei Ohtani was signed to the largest baseball contract ever awarded after his second Tommy John surgery in 2023.
“Ohtani is the greatest two-way player since Babe Ruth,” Dr. ElAttrache said. “The Dodgers have so much confidence in this procedure that they were willing to guarantee him three-quarters of a billion dollars immediately after the surgery — before he was even recovered enough to pick up a baseball again.”
Ohtani is scheduled to pitch his first game in September 2024, almost 50 years to the day after Dr. Jobe operated on Tommy John.
“It’s coincidentally written in the stars that this will happen right around the 50th anniversary,” Dr. ElAttrache said.
Starting pitcher for the Texas Rangers Nathan Eovaldi led his team to victory in the World Series after his second Tommy John performed by Christopher S. Ahmad, MD (New York), head team physician for the New York Yankees.
“I had the good fortune of having Dr. Jobe teach me how to do this procedure as a fellow,” said Dr. Ahmad. “We have made some technical improvements that lead to even better outcomes, even after a second injury.”
And today, Dr. Ahmad says, second injuries to the UCL are becoming increasingly common as throwing athletes of all ages are chasing after higher and higher velocity.
“It used to be that a 100-mph fastball was rare,” Dr. Ahmad said. “Today, every team has at least one player who can do that. The quest for velocity is starting with young athletes training like pros. They are pushed to be stronger, faster and bigger at younger and younger ages. But we can’t make their ligaments stronger and, in many cases, the UCL cannot hold up.”
Dr. Ahmad now performs several hundred Tommy John surgeries a year on athletes of all ages. In addition to operating on the pros, he has performed the procedure on eight members of a single baseball team at Columbia University and on many high school athletes.
“The procedure works very well, but recovery takes time,” Dr. Ahmad said, “It’s devastating for the high school athlete who is in the middle of their recruitment process for college, and they miss an entire season and often their scholarship opportunities.”
For all athletes, Dr. Ahmad recommends diversifying — playing other sports off season. And staying aware that ongoing pain inside the elbow is not normal and needs to be evaluated. But for those who do get injured, whether they are amateurs or pros in the Major Leagues, one thing is certain: Tommy John surgery can save their pitching arm.
“We can return athletes to the sport they love — to America’s pastime,” he said. “It’s really special for us as surgeons to keep dreams alive.”
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Disclaimers:
The InternalBrace surgical technique is intended only to augment the primary repair/reconstruction by expanding the area of tissue approximation during the healing period and is not intended as a replacement for the native ligament. The InternalBrace technique is for use during soft tissue-to-bone fixation procedures and is not cleared for bone-to-bone fixation.
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