Tommy John surgery is known in medical practice as ulnar collateral ligament (UCL) reconstruction and is common among athletes. The procedure was first performed in 1974, and is named after the first baseball player to undergo the surgery, major league pitcher Tommy John, whose 288 career victories rank seventh all-time among left-handed pitchers.

Tommy John surgery is a surgical reconstruction of an injured UCL. The UCL is the “duct tape” that stabilizes the inside of the elbow. When a pitcher throws, he places force on this ligament as he whips the ball. The injury that leads to a surgical reconstruction of the ligament is a partial or complete tear. Research has shown that the elbow UCL ligament gets injured more often when there’s poor range of motion at the shoulder, so the first way to deal with the injury in the elbow is to look at what’s not happening in the shoulder.

Is there research to show that this invasive Tommy John surgery, which involves drilling holes in the elbow and stringing a hamstrings tendon to take the place of the UCL ligament, actually works? At the time of this writing, there doesn’t appear to be a single randomized controlled trial that compares the effectiveness of the surgery with doing nothing. Baseball statistics, however, show that that despite reasonably high rates of return to pitching, pitching performance goes down after surgery. ERA goes down, WHIP (Walks and Hits per Innings Pitched) goes up, and the number of innings pitched goes down. Why? The reconstructed ligament never will have the normal biomechanics of the original equipment.

One could make the argument that if a pitcher isn’t throwing all that well before the surgery, what does he have to lose? Quite a big, based on research published June 6, 2014 in Clinical Orthopaedics and Related Research. In a study of 17 pitchers whose surgical grafts were well maintained and hadn’t ruptured, only 53 percent returned to pitching. Another study published in the June 2014 issue of the American Journal of Sports Medicine paints a picture different than what most people believe about the procedure. Career longevity after returning to play was only three years, with major- and minor-league baseball players pitching longer than college or high school players. This last part is a bit disturbing, as most college or high school pitchers who would opt for this surgery have big dreams of entering the major leagues. The inversion of recovery, with older patients paradoxically doing better than younger ones, appears to be the result of other motivating factors such as the older players strong need to maintain established professional income.

Tommy John surgery is major reconstructive surgery. Statistics indicate that the surgery reduces performance. In addition, many pitchers who have the surgery never make it back to high levels of play. Because the injury has been shown to be a shoulder problem masquerading as an elbow issue, aggressively operating on the elbow may be ill-advised.

“What Does Tommy John Surgery Research Show?” first appeared as a post on the Regenexx blog.