Teams may be too quick to turn players over for Tommy John surgery

Organisations are turning too quickly to players having Tommy John surgery rather than letting the injury heal with therapy.

Bobby Parnell was lost to the New York Mets in the first week of the season and later for the remainder of the year when the relief pitcher elected to have Tommy John surgery rather than rehabbing hisShow more

Whether or not Tommy John gets inducted into the Baseball Hall of Fame, the surgery that bears his name looks certain to be part of the game for years to come.

Tommy John surgery – or ulnar collateral ligament reconstruction, as it is known to the medically inclined – has been on the lips of people around baseball this season.

A staggering 32 players in organised baseball already have undergone the surgery this year, 17 of them major-league pitchers. That is more Tommy John procedures, barely one month into the season, than the sport averaged over a full season from 2000 to 2011.

When the repeated stress of pitching frays or tears the ulnar collateral ligament, surgeons attempt to stabilise the elbow by replacing the ligament with a tendon from elsewhere in the body or from a cadaver.

While pitchers undergoing the surgery spend an average of 18 months in recovery, the results appear to justify its popularity.

Eighty-three per cent of the 216 pitchers who underwent Tommy John surgery from 1986 to 2012 returned to pitch in the majors, according to a study in the American Journal of Sports Medicine, and 97 per cent at least made it back to the minor leagues.

A 2007 University of Pennsylvania study found that 56 of 68 major leaguers experienced no significant change in earned-run average, walks or hits per inning after the surgery.

When there is an option on the table with such tremendous success, people will take notice.

What is worrying, though, is that it appears players and their handlers are choosing Tommy John surgery as a first, rather than last, option.

Dr James Andrews, an expert on Tommy John surgery, told the Washington Post he had convinced several club general managers not to choose the procedure for their young pitchers.

“They say, ‘Please go ahead and do it. We want to get it done now, as opposed to waiting’,” Andrews said. “There’s a myth that there’s a 100 per cent success rate and pitchers come back throwing harder. It’s not true. If pitchers come back throwing harder, it’s not because of the ligament. It’s because of the rehab and the core-strength training.”

The trend of increasing arm injuries is somewhat counter-intuitive as pitching’s biomechanics are better understood than ever, and teams are investing more money and resources to keep pitchers healthy.

If nothing else, it is forcing teams to find new ways of managing their pitchers. In 2012, the Colorado Rockies started a “piggyback” system in which they carried four starters and several long relievers with the plan of having two pitchers carry the traditional starter’s workload.

The Houston Astros followed suit this year, and while on-field success may elude those teams, limiting major arm injuries and protecting their investments might be reason enough to celebrate.

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