Innovation in Tommy John Surgery: How the Most Important Procedure in Baseball is Changing | February Editor’s Choice

By Martinus Megalla | Senior Editor

Illustration by: Michelle Shi | Director of Art & Layout

Major League Baseball teams are businesses and just like any other business, their goal is to create and sell a product. As a result of the increasing popularity and revenues in baseball, MLB players are being paid more than ever before. Starting pitchers are among the highest paid players in baseball with players like David Price and Zack Greinke receiving contracts totaling 217 million and 206.5 million respectively. 1 It makes sense then that teams devote an enormous amount of time and effort into ensuring that these players are protected from injury and can be treated both quickly and effectively when injuries do arise.

Perhaps the greatest injury concern among starting pitchers is a torn Ulnar Collateral Ligament (UCL) in the elbow. This injury is extremely prevalent among baseball players of all ages and hundreds of MLB players have undergone Tommy John Surgery to repair a torn UCL since Dr. Frank Jobe originated the procedure in 1974. In his Spring 2015 article, “The Surgery that Has Helped People Keep Their Millions,” William Shin details this procedure, describing diagnosis of a torn UCL, treatment options, and studied success. He mentions briefly the future of Tommy John surgery and there have indeed been many studies and innovations to this famed procedure. 2 In particular, some promising advances include UCL repair, platelet-rich plasma injections, and stem cell therapy.

In a 2014 study assessing outcomes from Tommy John surgery, Dr. Erik C. Makhni et al. found that the average length of recovery was 16.8 months and that 80% (of the 140 players studied) return to sport. 3 This means that a player undergoing Tommy John surgery will miss about a season and a half of baseball on average, if he can even play again, which is detrimental to both the player and his team. Luckily, there have been changes to the procedure itself and even alternate treatment options that are promising in terms of drastically reducing this recovery time.

One such alternative is UCL repair as opposed to UCL reconstruction, which is the typical mode of Tommy John surgery. A 2017 study examining the efficacy of UCL repair found an 87% return to sport rate with an average recovery time of about 6 months. 4 This study shows that UCL repair is clinically effective while providing similar outcomes and shorter recovery times compared to UCL reconstruction.

Another interesting alternative that has developed recently is the use of platelet-rich plasma (PRP) injections. A 2013 study in the American Journal of Sports Medicine sought to obtain results from injecting 34 athletes who had suffered a partial UCL tear and failed to return to sport following non-operative treatment. 5 They administered platelet-rich plasma injections at the UCL for these athletes and found that 88% (30 of the 34 athletes) returned to the same level of competition without complaints with an average return time of 12 weeks. This study shows PRP injections can be a viable treatment option for players who have suffered a partial tear in their UCL and may help them avoid Tommy John surgery along with its lengthy recovery period.

One final area of interest is the use of stem cell therapy. Dr. James Andrews—a leader in orthopedic surgery who has treated thousands of athletes—and his team at The Andrews Institute are at the helm of exploring the efficacy of stem cells in terms of aiding recovery from surgeries such as Tommy John. 6 Although the research is still in its early stages, Dr. Andrews and his team have “treated at least 200 patients with their own stem cells” and he has referred to this treatment as “the most important revelation since the arthroscope.” The preliminary results have been promising and time will tell how revolutionary stem cells can be in sports medicine.

When Tommy John surgery was first performed in 1974, it changed the game of baseball forever and has since helped lengthen the careers of countless Major League Baseball players. Research focusing on injury prevention and treatment has led to the improvement of this procedure and will continue to build upon the initial work of Dr. Frank Jobe. With the rise of alternative methods like UCL repair, platelet-rich plasma injections, and stem cell therapy, doctors can continue to strive for the most effective treatment and recovery options for players. These innovations are beneficial to medical professionals, athletes, and fans of the great game of baseball alike.

1. Highest Paid Players, Cot’s Baseball Contracts. Baseball Prospectus Web site.
2. Shin, William. The surgery that has helped people keep their millions. Medical Dialogue Review. 2015;16: 30-33.
3. Makhni EC, Lee RW, Morrow ZS, Gualtieri AP, Gorroochurn P, Ahmad CS. Performance, return to competition, and reinjury after Tommy John surgery in Major League Baseball pitchers: a review of 147 cases. American Journal Of Sports Medicine. 2014;42(6): 1323–1332.
4. Erickson BJ, Bach BR, Verma NN, Bush-Joseph CA, Romeo AA. Treatment of ulnar collateral ligament tears of the elbow: is repair a viable option? Orthopaedic Journal Of Sports Medicine. 2017;5(1).
5. Podesta L, Crow SA, Volkmer D, Bert T, Yocum LA. Treatment of partial ulnar collateral ligament tears in the elbow with platelet-rich plasma. American Journal Of Sports Medicine. 2013; 41(7): 1689-1694.
6. Bishop, Greg. At the Andrews Institute, stem cells are seen as the next stage in sports medicine. September 27, 2017.

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