Vincent Key, MD, an orthopedic sports medicine physician at The University of Kansas Health System Sports Medicine and Performance Center, explains Tommy John surgery and offers advice to parents of young baseball pitchers.
Q: Let's begin at the beginning. While we hear of the procedure often, what exactly is Tommy John surgery?
A: Tommy John surgery can be compared to anterior cruciate ligament (ACL) surgery – instead of the knee, it's the elbow. The ulnar cruciate ligament in the elbow fails, so pitchers lose velocity and can't determine where the ball is going. So, we surgically rebuild that ligament in the elbow.
Q: Tommy John surgery among young baseball pitchers has been called an epidemic. Is it really that widespread?
A: While the surgery has become more common – even among college, high school and unfortunately, even middle school players – I wouldn't say it's an epidemic. I would say it's more a matter of the chickens coming home to roost. Athletes are playing baseball at younger and younger ages, with many playing year-round.
I don't agree with people who say don't worry because the kids are young and they'll be fine. I'm like a bean counter when it comes to pitching. Each pitch, each throw equals one click. Injuries result as generalized wear and tear on the arm.
Q: What would you tell the parents of young baseball pitchers? How can they help their children avoid this injury?
A: My best advice is to just let a kid be a kid. Playing more is not better. Playing smarter is better.
I strongly advise that kids don't play baseball – or any one sport – all year-round. Young athletes need time off. Their bodies are constantly changing and taking time off helps make sure their bodies are ready to safely play.
Some parents think their athlete should get Tommy John surgery prophylactically and that shows they don't understand the process. Tommy John surgery fixes the wounded ligament, not what caused the injury in the first place.
The elbow is a victim of the rest of the body not working quite right. The shoulder, shoulder blade, lower body, hips, hamstrings – those parts need to be stretched and strengthened. Otherwise, the pitcher will throw through the elbow, trying to create velocity at the end of the throwing cycle. And that creates the injury.
Q: If a young athlete does require Tommy John surgery, what should the player expect? The parents? The coaches?
A: Getting Tommy John surgery is not like hitting a "reset" button. I tell athletes it's not like they have a brand-new engine in their arm. I just fixed the ligament. But it's up to them to fix what caused the ligament to fail in the first place. Otherwise, they're going to be what I call a two-time offender – they'll come right back for another surgery.
It's vital to temper expectations. A high school pitcher who has Tommy John surgery has a 70% chance to make it back to playing in high school – that's not college, the minors or the majors – that's the odds of playing high school baseball again.
Q: What is the difference between Tommy John surgery and UCL bridge and repair?
A: The biggest factor is the youth of the athlete. The younger the patient, the more likely you're able to do a repair, as opposed to a reconstruction, because you don't have the wear and tear of the ligament. When you're talking about a repair, you're talking about athletes getting back to their sport in 6-9 months, as opposed to a reconstruction, which is 12-14 months.