Tommy John is the common name for Ulna Collateral Ligament Repair. This surgery has been thought to improve pitching skill in asymptomatic athlete by the media, athletes, parents, coaches, trainers and agents. In a retrospective investigation, by Erickson et al (2014) the return to pitching and performance following Tommy John surgery was investigated[1].

What I Read

 

Take Home Points:

  1. The authors report that reconstruction of the UCL allows for a predictable and successful return to professional baseball
  2. Performance declined before surgery and improved after surgery compared to matched controls

 

Thoughts

  1. It is a concerning thought that Tommy John will improve an asymptomatic pitcher’s skill amongst the media, athletes, parents, coaches, trainers and agents. This study does not help this thought.
  2. The rehab procedures were NOT analyzed, but overall pitchers had improved performance. I would be interested to examine the clusters of responders vs. non responders. What was unique about the responders vs. non-responders and were there extreme outliers / responders. Was it the surgical procedure, the rehab, the duration of rehab, pre-surgery characteristics, etc? Remember that statistics were analyzed based on the mean scores.
  3. It is possible to treat UCL-strain conservatively – shorter recovery time (24.5 weeks post Dx) vs. 81 weeks on average for UCLR (That is still roughly 4 times the recovery time vs. conservative therapy). I’m curious what would happen if a pitcher took the same amount of time to rehab conservative vs. UCLR rehab. Sometimes surgery makes recovery possible because you must wait.
  4. I thought UCLR was more common than the reported 10% in MLB and amateurs. Therefore how are the remaining pitchers staying healthy? I’m going to investigate the number of pitchers that are able to throw asymptomatically.

 

Notable Points from the Article:

 

Commonality of UCLR: 10% of all MLB Pitchers and amateurs

Reason for UCLR: decreased velocity, decreased innings pitched, decreased performance – ERA, hits, whip, losses etc.

Operationalizing RTP = 1 game at the MLB level

Rate of Return to Pitching after UCLR: 148 /179 (83%) & 174/179 were able to RTP @ MLB & Minor Leagues combined

Time to RTP after UCLR:  Avg: 20.5 months +- 9.72 (that is a long time to recover)

Performance After UCLR compared to controls: (all are statistically significant)

  1. –VE: fewer innings pitched
  2. lower ERA
  3. lower WHIP
  4. lower losing percentage
  5. gave up few hits / inning

 

Most common complication with UCLR = ulnar neuropathy

 

  1. Erickson, B.J., et al., Rate of return to pitching and performance after tommy john surgery in major league baseball pitchers. Am J Sports Med, 2014. 42(3): p. 536-43.