Tommy John surgery offers pitchers long-term success


For generations, a Tommy John injury spelled the end of a pitcher’s career. With the development of ulnar collateral ligament (UCL) reconstruction, baseball players could return to throwing at a competitive level. Now most studies show rates for return to sports after Tommy John surgery between 80% and 90% for one year after surgery.

Clearly UCL reconstruction has been crucial for helping baseball players return to play. But does it help them long term? Or is it a short-term fix?

Pitching after Tommy John surgery
A study presented recently at the American Orthopaedic Society for Sports Medicine’s Annual Meeting provides evidence that this surgery offers good long-term outcomes as well.

Also read:
Ask Dr. Geier – Tommy John injuries
The misperceptions of Tommy John surgery

Daryl C. Osbahr, MD and others contacted 256 of the 313 patients who were a minimum of 10 years removed from Tommy John surgery by Dr. James Andrews. They collected data on time required for return to baseball, length of career after surgery, reason for retirement and more. Among the 256 reached for the study, 89% were pitchers. 24 baseball players were major leaguers, and 88 were minor leaguers. 104 played college baseball, and 40 played at the high-school level.

The study gives encouraging results for baseball pitchers:

• 83% of the baseball players in this study returned to the same or higher level of play.
• Length of the baseball career after UCL reconstruction averaged 3.6 years.
• 93% were satisfied with the results of their UCL reconstruction at a minimum for 10 years after surgery.
• Only 3% of the baseball players had elbow pain, and only 5% of players complained of limited elbow function.
• 92% could throw now without elbow pain.
• 98% could participate in throwing activities at least recreationally.

“UCL injuries used to be considered career-ending. Now players are consistently able to return to play at a high level while also enjoying excellent long-term outcomes,” Osbahr remarked.

While these results are encouraging, I think we can lose sight of the prevention aspect of UCL injury. Overuse and flaws in pitching mechanics contribute to these injuries. Even though surgery does get pitchers back on the mound, it takes a year or more. And return is not guaranteed, especially for younger athletes.

If parents, coaches and doctors can work together to help keep some of these players from needing Tommy John surgery in the first place, that effort would provide the best long-term outcome.

Note: The following post appears in a modified form as an article I wrote for Becker’s Orthopedic Review.