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Tommy John: The man behind the surgery

Christopher Horner | Tribune-Review
Pirates starting pitcher A.J. Burnett delivers during the sixth inning against the Cardinals Saturday April 21, 2012 at PNC Park. The right-hander had Tommy John surgery in 2003.

Elbowing their way back

A torn ulnar collateral ligament used to mean the end of a pitcher's career, but since Tommy John had the first transplant surgery in 1974, many pitchers have successfully come back. Some notable examples:

Pitcher Before After

Tommy John (1974) 124-106, 2.97 ERA 164-125, 3.66 ERA

David Wells (1985) Minor leagues 239-157, 4.19

John Smoltz (2000) 157-113, 3.35 56-42, 154 saves, 3.28

A.J. Burnett (2003) 30-32, 3.86 100-81, 4.15

Josh Johnson (2007) 12-10, 3.50 41-18, 2.95

Tim Hudson (2008) 146-77. 3.48 41-23, 3.14

Stephen Strasburg (2010) 5-3, 2.91 10-3, 2.37

Note: Current pitchers stats through Friday

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Saturday, June 30, 2012, 10:44 p.m.
 

News arrived last week that Daniel Hudson of the Arizona Diamondbacks has a torn ulnar collateral ligament in his right elbow. He will join an expanding list of major league pitchers, including the Pirates' Charlie Morton, who had Tommy John surgery this season.

In a side note, the first pitcher to undergo the surgery said on the phone from New Jersey, “The current players and the current fans don't have any idea who Tommy John was.”

That was Tommy John speaking. Perhaps it was a slight exaggeration. But the gist is that people know little beyond his name, which is permanently attached to the surgery that saved his career and dozens of others that followed.

“He's the reason we call what I had,” said Pirates right-hander A.J. Burnett, who had Tommy John surgery in 2003.

But many who play and follow the game, including Burnett, are unaware of much else, like John's 26 big league seasons, his 288 wins (164 after the surgery), his 700 starts (eighth all-time) and that he pitched until he was 46. He made four All-Star teams, twice finished second in Cy Young balloting and went 6-3 with a 2.65 ERA in 14 postseason games with the Dodgers, Yankees and Angels.

“People just know me from the surgery,” he said.

Burnett said he knew Tommy John was “a pretty good pitcher,” that “he pitched for a long time” and that was it. Pirates reliever Brad Lincoln, who had Tommy John surgery in 2006, admitted, “To be honest, I really don't know a darn thing about him.”

John, who retired in 1989, is neither bitter nor angry. He is, in fact, proud of his legacy, of being part of the language, if not a brand (“Tommy John surgery. Ask for it by name.”)

“Tommy John surgery will be around when Tommy John is nothing but dust in the coffin,” he said from his home in the resort town of Crystal Springs, N.J.

Still, perhaps at some point, a pitcher about to have Tommy John surgery “would call Tommy John and ask him what he would have to do to get pitching again,” he said. “But that's not part of the deal.”

Tommy John (it sounds better saying the whole name) has a long memory that can easily summon contract battles with the Dodgers and George Steinbrenner, but no time to dwell on petty annoyances. He hates wasting time, period. For example, he loves to hit golf balls, and he's pretty good, but he rarely plays a full round. “I don't want to spend five hours doing it,” he said.

At 69, he remains fit and active. He does some scouting for a sports agency, works when he feels like it for a scoreboard company and has a baseball academy. He speaks to various groups once or twice a month. He used to coach and manage in the minors. It was there, he said, that pitchers occasionally would acknowledge their gratitude.

One who did was Pirates reliever Jason Grilli, who had Tommy John surgery a decade ago. Grilli said he told John, “Thanks for being the guinea pig, man.”

“It was kind of a neat moment,” Grilli recalled. “He saved a lot of guys' careers.”

One in a hundred

Pitching for the Dodgers against Montreal in August 1974, John took a 13-3 record into the game and left with something terribly wrong in his left elbow. On Sept. 25, after several weeks of rest and therapy, accomplished nothing, Los Angeles orthopedist Frank Jobe replaced the shredded ulnar collateral ligament in John's elbow with a tendon from his right wrist. No one had attempted such a thing before. John was 31. He had 124 wins in a career that began 11 years earlier with the Indians. Without the surgery, the win total and the rest of his stats would have remained stuck in history.

The classic crafty southpaw, John did not throw particularly hard. Nor was the culprit the killer sinker he learned while pitching for the White Sox. His arm frequently hurt, but that was part of the game. The problem was the repeated cortisone shots through the years that weakened the elbow. Regardless of the reason, he was ready. Jobe said his chances of pitching again were 1 in 100. “Let's do it,” he told Jobe.

“Until then, if something like that happened, you were through,” said Jobe, who will be 87 next month and still lives in LA. “I had done some tendon transfers (with polio patients) to strengthen joints. This was for an entirely different purpose, but I knew I could handle the surgery. The question was, was it going to work?”

With Jobe assisted by several other doctors, the operation lasted about 312 hours. All went well, except that afterward John's wrist began to hurt, leaving him with a case of “claw hand.” Jobe later realized he drilled a hole too close to the nerve. He had to operate again and move it.

“Dr. Jobe is amazing,” said Mets medical director Dr. David Altchek, who has performed numerous Tommy John surgeries. “Really amazing. He's been a mentor to so many of us.”

Dodgers trainer Bill Buhler helped guide John through rehab, part of which included playing catch with his wife, hot and cold treatments, whirlpool and ultrasound. For the nerve damage, he squeezed Silly Putty. Eventually he threw longer and harder. John missed the entire 1975 season. In his third start in 1976, he won for the first time in 21 months, beating the Pirates, 7-1, at Dodger Stadium.

“I thought he was a lot better pitcher after the surgery,” said Al Oliver, the Pirates first baseman/outfielder who was in the lineup that night. “The thing that was amazing to me was the movement he had on the ball. His location was super. He threw the ball right where he wanted. He was just superb when he came back.”

John finished the year with a 10-10 record and a 3.09 ERA. The next season he won 20 games for the first time, helping the Dodgers get to the World Series. By the time he was finished, he faced 34 Hall of Fame hitters, Hank Aaron to Robin Yount, plus Pete Rose, during a career that spanned Stan Musial to Ken Griffey Jr. and the terms of seven U.S. presidents.

Jobe, meanwhile, waited three years before he performed his next ulnar transplant, on pitcher Brent Strom.

“I wanted to make sure Tommy's arm didn't come apart on me,” said Jobe, who said he went on to perform the operation about a thousand more times.

No one's listening

Major League Baseball is experiencing what Angels medical director Lewis Yocum calls an “epidemic” of Tommy John surgeries this year. Within a week earlier this month, four pitchers, including Morton, had the procedure (so did Pirates prospect Ryan Beckman). Four Kansas City Royals pitchers have had their elbows rebuilt since Opening Day.

About 60 current big league pitchers have had or are recovering from Tommy John surgery. The success rate is high, about 85 to 92 percent, according to surgeons and trainers. Active pitchers who came back include Burnett, Chris Carpenter, Tim Hudson, Joe Nathan and Josh Johnson. Nationals phenom Stephen Strasburg appears to be better than ever.

The procedure had mixed success in the 1980s and '90s, but new surgical techniques — like using a tendon from the thigh instead of the wrist — and improved rehabilitation methods have made the operation and recovery more efficient. The standard return time is about 12 months. But Mike Reinold, the Red Sox' head physical therapist, cautions that “there is a false perception that this is a slam dunk. It's a long and winding road to get back.”

Studies by the American Sports Medicine Institute in Birmingham, Ala., founded by renowned orthopedist James Andrews, and other organizations show UCL injuries and surgeries on the rise.

“There's been a dramatic increase, especially with the younger pitchers,” said Dr. David Geier, director of sports medicine at the Medical University of South Carolina. “It used to be with pro athletes, but now we're seeing it in college and high school.”

The main reason, according to widespread agreement in the medical community, is that pitchers, especially young pitchers, often throw more than they should.

“Too many pitches a week, pitching too many times a week,” Geier said. Faulty mechanics has been cited as a secondary reason.

“The No. 1 factor we continue to see is overuse,” Reinold said. “We see our kids being pushed more and more at an earlier age.”

Said Yocum, “Kids that used to play football and basketball are now playing baseball year round.”

Andrews' Sports Medicine Institute, doctors and other organizations have warned against overuse. Geier frequently talks to baseball organizations about the dangers. A 2006 ASMI study reported that pitchers who threw more than eight months a year were five times more likely to require surgery. Since then the injuries have increased.

“No one's listening,” said John Smoltz, a former Braves All-Star, now a broadcaster for MLB Network. “Parents aren't listening. Coaches aren't listening. We're adults. Those kids are not.”

“Public awareness is a factor, but the golden carrots are pretty attractive,” said Yocum, a Jobe disciple and a leading practitioner of Tommy John surgery for 35 years. “The college scholarships, the $3 million bonuses. They all want to be superstars.”

Andrews has likened the negligence of parents and coaches to child abuse. John agrees.

“Some parents are living their lives vicariously through their kids,” he said. “The best pitchers in the world, they don't throw year-round. Why should your kid, who's underdeveloped, has no leg strength, no nothing? Take four months rest. Play basketball, run cross-country. Do something else.”

Bob Cohn is a staff writer for Trib Total Media. He can be reached at bcohn@triblive.com.

 

 

 
 


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