Tommy John surgeries have not changed much in the last 10 to 15 years. What has changed has been the huge increase in the number of athletes who suffer a Tommy John injury and undergo Tommy John surgery.
According to Grantland’s Jonah Keri, 25% of major league pitchers and 15% of minor league pitchers have undergone Tommy John surgery. While only professional and elite athletes required that surgery in previous decades, kids younger than ever are going under the knife. Keri notes that adolescents comprised 40% of UCL reconstructions performed at the American Sports Medicine Institute in 2010.
While they are only in their infancy, two novel approaches might one day change the way we monitor pitchers for budding elbow problems and treat athletes who develop these injuries.
A compression sleeve to predict UCL injury?
In Spring Training, many major league pitchers tested a new compression sleeve called the mThrow. This sleeve has six sensors built into it. A pitcher wears the sleeve on his forearm with the sensors placed directly over the ulnar collateral ligament (UCL) – the ligament injured that usually leads to Tommy John surgery.
In theory, the mThrow sleeve offers pitchers and their coaches or athletic trainers the ability to monitor the stress directly on the UCL as the forearm muscles start to fatigue during a game or pitching session. They could also recognize subtle changes in the pitcher’s arm slot or elbow position as his arm tires that might not be apparent simply by watching him throw. Rather than relying simply on pitch counts, the coach could use this sophisticated information to better decide when to pull a pitcher out of a game.
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The mThrow could also be applied to decisions made between starts and over the course of the season. The sleeve’s app reportedly tracks the volume of stress over time. If the sensors revealed that the UCL experienced higher than normal stress for a large number of pitches, then a coach might give him an extra day of rest between starts or skip the next one altogether.
A new surgery to get pitchers back quicker?
Even with the potential to prevent some UCL injuries, many pitchers will still suffer them. Historically, orthopedic surgeons have treated a Tommy John injury in the same manner. Since primary repairs of the torn ligament have shown poor results, surgeons perform Tommy John surgery to make a new ligament. Pitchers with different types of UCL injuries undergo that same UCL reconstruction, whether they suffer acute complete ligament tears, chronic injuries, or partial tears of the ligament. The pitcher misses 12 months or more rehabbing his arm and fighting his way back to sports.
Dr. Jeff Dugas, an orthopedic surgeon at the Andrews Sports Medicine & Orthopaedic Center in Birmingham, Alabama, has devised a novel surgery to treat a subset of these injuries – the partial tears. Instead of using a tendon in the wrist to rebuild the UCL, he now implants a tape filled with collagen. He sews it to each side of the ligament and anchors it to the bone on each side of the elbow. Think of it as a reinforced repair of the ligament.
In an interview with Mike Vorkunov of NJ.com, Dugas described the tape as “Strong enough to tow a car with, basically.”
Dugas is quick to point out that the results with this procedure are preliminary. He has only used this technique on high school and college athletes and not pros. He has treated 30 athletes in the last 20 months using this surgery, and he has seen good outcomes. They usually return to sports in six months, half a year or more quicker than pitchers return after Tommy John surgery.
“This is so early I’m being cautious not to tout this as the second coming,” Dr. Dugas observed. “This is definitely early in the process and they could all fall apart tomorrow but the early data is very promising.”
Are these approaches to Tommy John injury promising?
These results are exciting. The future of sports medicine lies not in simply finding better surgeries to treat a Tommy John injury in athletes and active people, but also to prevent them in the first place or treat them in a way that is as minimally invasive as possible.
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It’s critical to point out, though, that we don’t know if either of these approaches will work to prevent injuries or improve outcomes. We need much more data with hundreds or thousands of pitchers followed over many years. They might each prove to be hugely valuable, or they might not work at all. In the meantime, we must continue to focus on and eliminate the underlying risks of overuse that lead to Tommy John injury in the first place.
One day we will find a breakthrough. Maybe it will be a monitoring device, a training technique, a nonoperative treatment or some other advance – maybe even Dugas’s surgery or the mThrow – that changes the game for young pitchers.
Note: A modified version of this post appears as my sports medicine column in the April 28, 2015 issue of The Post and Courier.
Recovery from Tommy John surgery in 6 months? How Mets and Yankees are helping MLB solve elbow injury epidemic. By Mike Vorkunov of The Star-Ledger. April 24, 2015.
Tech Talk: MLB pitchers using mThrow sleeve to monitor UCL workload. By Tim Newcomb of Sports Illustrated. April 7, 2015.
The Tommy John Epidemic: What’s Behind the Rapid Increase of Pitchers Undergoing Elbow Surgery? By Jonah Keri of Grantland. March 10, 2015.