Jobe's Probe Revolutionized Baseball
Tommy John Surgery A Saving Grace
By John E. Sacco

In the spring of 1976, the Los Angeles Dodgers gave pitcher Tommy John all of two starts to prove he could pitch effectively after having surgery to repair a torn ligament in his left arm and rehabilitating it for more than a year.

The moment John was diagnosed with the injury during the 1974 season, he knew his chances of returning to the major leagues were not good.

Dr. Frank Jobe, who was the Dodgers' team physician at the time, before performing exploratory surgery told John his chances of pitching again in the big leagues were one in 100.

For John, that one chance was hope. For the baseball world, particularly pitchers, it is salvation.

John had the surgery and returned to the pitching mound in 1976. He did well enough in that second start to keep his spot on the Dodgers' roster and resurrect a career that spanned the presidencies of John F. Kennedy and George Bush.

If not for Jobe's skill and deft surgical touch or John's determination, pitchers today might not be able to overcome torn ligaments in their arm and come back stronger than before.

The surgery that Jobe performed on John became known as "Tommy John" surgery. While Jobe is clearly the father of the procedure, Dr. James Andrews, based in Birmingham, Ala., seems to have come as close to perfecting the surgery as one could. He is the preeminent Tommy John surgeon.

What Is It?

The ulnar collateral ligament is a band or sheet of fibrous tissue that connects two or more bones and supports the arm muscles used while pitching. It is located on the inside of the elbow. If the ligament is torn or damaged, it is impossible to gain velocity while throwing any object, especially a fastball.

Jobe extracted a tendon from John's right arm and used it to replace the torn ligament on his left, pitching arm, threading the healthy tendon through holes drilled into the bone above and below the elbow.

At the time of Jobe's experiment, no one could be certain or even guess at the outcome. John went on to win 170 games after the surgery.

A lot of pitchers have come back from the surgery, some with more velocity than before the surgery. Others simply haven't been able to overcome. It's difficult to place any meaningful statistical numbers on recovery rates because it's hard to verify purely through statistics if a pitcher is better or worse after the surgery.

One thing is certain, Tommy John surgery has saved a lot of careers and continues to become more commonplace among major league, minor-league and amateur pitchers.

The Pirates' Kris Benson, one of five Pittsburgh players to undergo Tommy John surgery in 2001, can't begin to imagine what it was like for John to be the first, the guinea pig.

"It would be tough not knowing what might set you back or what might end your career," Benson said. "At that time, they didn't know if he was ever coming back. I can't imagine being the first one going through experimental surgery, particularly when they are putting a scar on your arm and drilling holes in your arm."

Common John

Those in baseball hear about a pitcher undergoing Tommy John surgery quite frequently. Obviously, the most publicized of the surgeries are performed on major leaguers.

But players and pitchers at all levels are not immune to tearing ligaments.

The Pirates alone had four pitchers last season, Francisco Cordova, Ryan Vogelsong and minor-leaguer Bobby Bradley, and infielder Mike Benjamin undergo the surgery.

Three of seven pitchers Baltimore Orioles' Vice President of Baseball Operations Syd Thrift acquired in a series of July 2000 trades reported to spring training 2001 with arm injuries. One had to undergo Tommy John surgery.

The Chicago White Sox suffered through a rash of arm injuries in its farm system prior to the 2001 season.

Kurt Ainsworth, one of San Francisco's prized pitchers, underwent Tommy John surgery at 17-years-old. He became the first player to have the surgery to be taken in the first round of the June free agent draft. Ainsworth throws as hard or harder today and is one of the Giants' most prized possessions.

Eleven months after having Tommy John surgery, Arizona State's Mike Esposito, a red-shirt freshman, limited California to four hits and two runs while striking out six in a career-high seven innings to earn a victory in his third start back.

Those kind of success stories excite and encourage Vogelsong, who tore ligaments in just his second start for the Pirates, who had acquired him at the trading deadline in July from San Francisco.

"It never entered my mind that my career was over," Vogelsong said. "Seeing all the success rates was encouraging. I just wondered if I would ever get the chance to prove I'm good and take my pitching to another level."

Vogelsong has found great inspiration from Benson, who doctors say had one of the best Tommy John surgeries they've seen and has an incredibly clean and smooth rehabilitation.

On The Mend

Benson and Vogelsong have spent the winter working out at PNC Park. Benson has been a sounding board for Vogelsong.

"He's helped me out a great deal," Vogelsong said. "Kurt Ainsworth is my best friend. Talking to him, I knew what I was getting into.

"Just seeing Kris every day. . . he's in great shape. I watched him throw off the mound the first time. It was like he had just done it three days before. Knowing how good he looked after being out of the game for nine months is all I needed to see."

While John followed Jobe's advice of daily workouts, following a hot-and-cold therapy, which featured the alternation of ice baths and hot packs, the rehabilitation process has been enhanced. John also exercised his hand by doing the "Silly Putty" therapy, where one combined several eggs of putty and molded them into one ball. John kneaded the ball constantly in an attempt to strengthen his fingers while making them more mobile.

Vogelsong said Benson introduced him to message therapy in the first couple months of his recovery and also acupuncture to help spark circulation right after the surgery.

"Tommy John had no idea what was coming," Vogelsong said. "My rehabilitation is easier because I knew what was ahead and had Kris give me great advice and a model to follow.

"It's tough. I come in here five hours a day and that is every day. It takes a lot of dedication and hard work. But I want to get to an all-star level and if takes me being here every day to get there, that's what I'm going to do."

Routine Surgery

It wasn't that long ago a tear of the medial collateral ligament in the arm put a pitcher, even an athlete's career in jeopardy. But Tommy John surgery has been modernized, allowing for a pitcher to return, in most cases after a year of rehabilitation.

David Altchek, M.D. of The Sports Medicine Center at the Hospital for Special Surgery and former New York Mets' team physician, and his team of sports medicine specialists helped refine the surgery to the 45-minute outpatient procedure it is now. Prior to that research, the surgery took about four hours with a two-day hospital stay.

"The procedure is not as traumatic as it once was," Altchek said. "Through modernization of the treatments, the surgery has become much more reliable.

Most doctors who perform Tommy John surgery admit that it is difficult to put a number or percentage on the success of the surgery. Currently, there is no compelling evidence as to whether age, throwing certain pitches or certain arm angles increase an athlete's risk of tearing the ligament.

"The problem with an MCL tear is that it is not common," Altchek said. "Because it really only happens to elite athletes who exert high amounts of force on their arms, there aren't very many opportunities to learn about the injury.

"The injury occurs when a pitcher loads up on his pitches so much the ligament in his elbow tears. Unfortunately, there are no signs to predict who is at risk, nor is this type of injury that stretching or strength training can prevent."

Cause Unknown

The exact cause of a ligament rupturing is unknown. It could be wear-and-tear or it could be a single joint that rips the tissue away from the bone. The wide variety of breaking pitches used today, such as the sharp-curveball, cutter and split-finger fastball, can cause strain on the elbow, perhaps including these ruptures.

"Certainly, improper pitching technique can lead to elbow injuries, particularly injuries of this kind," said Dr. Patrick DeMeo, director of the division of sports medicine and vice chairman of clinical affairs for the Department of Orthopaedic Surgery at Allegheny General Hospital and member of the Pirates sports medicine staff and team physician for Duquesne University.

"That's not to say it can't happen to people who do have good technique. You definitely can expose yourself if you're not using good pitching fundamentals."

DeMeo said that pushing young pitchers to throw pitches they really aren't ready to throw can lead to elbow problems and ultimately to surgery.

"I am sure there are times when kids are being asked to do too much," DeMeo said. "Sometimes they are being taught improper fundamentals and at times kids are being asked to make pitches they are not ready to throw.

"If you're not pitching fundamentally or mechanically correct, you will over stress the elbow."

Dr. Tony Romeo, an orthopedic physician at Rush-Presbyterian-St. Luke's Medical Center, said too many kids are being pushed to throw too hard at an early age. "Typically, the injuries occur in kids who can throw more than 60 mph when young and then 70 mph when they get a little older."

Tearing the MCL can happen anytime. Again, there are not clearly defined reasons when the injury might occur or why it might happen.

Benson tore his ligament likely over the course of time. Vogelsong, who never felt any pain or had any warning signs, likely just blew his apart with one pitch.

"I think it just happened," Vogelsong said. "It was a freak thing that happened."

Comeback Trail

Benson and Vogelsong are not alone in their fight to return to the big leagues.

Several other pitchers face an uncertain 2002, including Arizona's Matt Mantei, Scott Williamson of Cincinnati, St. Louis' Garrett Stephenson and Scott Erickson of Baltimore, among others.

Benson sees the performances of the Cardinals' Matt Morris and Kerry Wood of the Chicago Cubs and understands that coming back better than before is possible.

He also notes that several pitchers who were named to the All-Star game last season had undergone Tommy John surgery in the past.

That group included his former Clemson teammate Billy Koch, then of Toronto and now with Oakland.

"The toughest thing is just trying to hold yourself back," Benson said. "It's difficult to accept that you're hurt. But when you get hurt and have this surgery, you have to accept the fact you're not coming back anytime soon.

"The best thing is to do the rehab, build strength and make the most out of the situation."