What is Tommy John Surgery? The Story Behind the Revolutionary Procedure

The stellar season of New York Mets starting pitcher Matt Harvey has grinded to a halt now that it has been discovered that he has a partially torn ulnar collateral ligament (UCL) in his right elbow. At only 24, Harvey may require the famed Tommy John surgery, which has helped many athletes, especially pitchers, extend their professional careers. Although you may have heard of the surgery, you may not know the story, or the man, behind it.  

On July 17, 1974, the Los Angeles Dodgers were playing the Montreal Expos. Southpaw Tommy John was on the mound. As one of the Dodgers' premier pitchers, John would go on to be one of baseball’s all time win leaders among left-handers, but that day something wasn’t right.

John described that day’s fateful injury to his throwing arm: “I threw a sinker and right as I threw, I felt this searing pain and the ball just blooped up to the plate and I went, 'Holy mackerel, what did I do?” John attempted one more dribbling pitch before leaving the mound. After several examinations, Dodgers physician Frank Jobe gave John his assessment. If the UCL in the elbow was detached he would need to attach a tendon from somewhere else in the body to the location. Jobe had an idea, but it had never been attempted.

A pitcher’s arm is his lifeblood — one major injury to the shoulder or elbow and his career ould be over. In 1974, medicine wasn’t advanced enough to allow a pitcher to return from serious damage to his throwing elbow until Jobe performed what would be the most revolutionary procedure in the history of the game.

Jobe put the success rate at 1 in 100, but he assured John his career was over without repairing the elbow. John gave the go-ahead, and Jobe’s surgery was successful. John was able to pitch again, logging another 164 wins before retiring after 26 seasons. Jobe eventually grew tired of describing the new procedure by its medical name, UCL reconstruction, so he named it after the man he first performed it on: Tommy John surgery. The name stuck.

The procedure is a graft reconstruction of the elbow’s ulnar collateral ligament. The UCL wears down with stress, and can tear from forceful throwing. Doctors open the elbow and insert a replacement tendon to connect the ulnar bone to the humerus in the upper arm. The replacement tendon is tightly woven through holes drilled in each bone. After the procedure, rehabilitation begins immediately.

Dr. Ken Yoshino, a prominent Southern California doctor of physical therapy, says the rehab is long and can take almost two years. “There is a biological timeline you must follow. Most pitchers can do light throwing six months after surgery, and can pitch again after 12 months. The tissue generally takes between 18 and 24 months to fully remodel with the new ligament.”

Knowing when to progress to the next level during rehab is key to avoiding re-injury.

Former Cleveland Indians pitcher Kyle Harper, who underwent Tommy John surgery in 2004, describes the moment of traumatic injury as a feeling of numbness. Harper and John both began to feel pain in their throwing arms when they were young (12 and 13). The two eventually required surgery as adults, and both report performing better after the surgery.

Because the surgery has allowed so many pitchers to return to the mound throwing harder than ever, some parents are having their teenage sons undergo the elective procedure before they injure their elbow, abusing a process that has been vital to baseball’s growth.

Bleacher Report’s Peter Richman says more discussion on the procedure is needed. “Tommy John surgery is so widely done in baseball, and it usually improves the pitcher’s performance. High school kids are getting it done before they even injure the UCL because there’s a good chance they will throw harder afterwards. It’s interesting we aren’t discussing this as a potential performance enhancing method.”

Harper doesn’t think the increased performance comes from the procedure itself, but is a result of increased training to rehab and strengthen the arm. As a pitcher throws his performance can plateau or decrease by wearing down the UCL. Performance after the surgery might increase simply because the elbow has been reset to its correct anatomical strength.

Most Americans have played a sport for fun at some point, but sports can also be a powerful driver of innovation across other fields. Advanced training – and an industry devoted to protective equipment – is extending the careers of athletes in all sports. This is especially the case in medicine when new procedures, like Tommy John surgery in 1974, make sure athletes get back on the field.

Not only has Tommy John surgery advanced the field of medicine, it has revolutionized the game of baseball. Pitchers can now prolong their careers past the point of serious injury. Some of the biggest names in baseball have had the surgery, including Eric Gagne, Brian Wilson, and Stephen Strasburg. Thanks to the work of Dr. Jobe, thousands of pitchers have been able to extend their baseball careers.

Because of his innovative efforts, Jobe was inducted into the Baseball Reliquary Shrine of the Eternals. America’s favorite pastime is forever in his debt.