Tommy John surgery – bionic or barbaric?

In January 2018, the Oxford English Dictionary added 1,100 new entries. Some, like mansplaining, I hear from my daughters in response to sage advice I impart.

Others, like hangry, are also directed at me, usually when I arrive home a little more irritable than normal, having worked through lunch.

Reading through the list, I was surprised to see the inclusion of the noun Tommy John.

Every baseball fan is familiar with the term. It usually cries the end of the season for yet another high-profile pitcher.

Even though the phrase Tommy John is in everyday baseball parlance, its OED inclusion was still surprising.

In a 12 year career spanning 1963 to 1974, Tommy John, a left-handed pitcher from Indiana, made 318 starts with 2.97 ERA. No matter how you judge it, he had an excellent career. But he wasn’t finished there.

At 32 years old, he suffered a horrendous injury and underwent controversial surgery which replaced the ligament in the elbow of his pitching arm with a tendon from his right forearm.

Not only did he make a full recovery, but he also went on to pitch for another 14 years, racking up 164 more wins, which remains the post-surgery record. He retired in 1989 at 46 years old.

Nowadays, UCL (ulnar collateral ligament) surgery is commonplace. Perhaps its frequency diminishes the severity of the procedure. There are plenty of horrific stories of Tommy John surgery being recommended to college pitchers with perfectly healthy ligaments.

In a sport where performance-enhancing drugs are completely unacceptable, the barbaric/bionic (delete as appropriate) practice of replacing an elbow ligament has become routine.

Just so there is no ambiguity, the surgical procedure involves harvesting a tendon from the forearm, hamstring or even the big toe. After cutting open the elbow area and removing the damaged tissue, holes are drilled in the humerus and ulna. The new tendon is then threaded in a figure-of-eight to secure the joint. Simples.

Diagram courtesy of Driveline Baseball

There is a widely held misconception that Tommy John surgery is straight-forward, without risk and that the pitcher recovers quickly to reach the same, if not better, level.

Of course, the vast majority of pitchers make a successful recovery, but there is an extraordinary number of exceptional pitchers who have failed to recapture their pre-injury form.

Surely there must be more risk attached to returning to an elite-level of performance than for a college or low Minor League pitcher?

Obviously, many other factors can contribute to a pitcher’s decline, and it is too simplistic to just blame UCL surgery, but that ruins my narrative. There are enough examples to suggest that we change our opinions of it as a routine procedure.

Matt Moore was so highly rated that Baseball Prospectus ranked him ahead of Mike Trout and Bryce Harper when creating their Top 101 prospects for 2012. The left-hander made 61 starts with 3.53 ERA when he reached the big leagues. Since undergoing Tommy John surgery in April 2014, his ERA is 5.25.

In fact, his 2018 ERA is over 7.00, so don’t expect the Rangers to pick up his $10 million club option for 2019.

Japanese phenom Yu Darvish made 88 starts with 3.27 ERA when he arrived in the USA. He underwent Tommy John surgery and has been limited to just 56 starts in the 3½ years since, and he is on the DL again.

Forget what you saw in 2018, Reds’ starter Homer Bailey was a top-25 pitcher during the three years prior to his surgery. He made 88 starts with 3.61 ERA to help secure a six-year, $105 million contract. He has been restricted to just 44 starts since 2015 with a woeful 6.29 ERA.

Mark Sheldon, the highly respected beat writer for the Reds, suggested a timetable that proved to be overly optimistic.

“Bailey’s recovery time is expected to be nine to 12 months”

In 2018, the number of Tommy John cases in MLB has declined compared to previous seasons, but it still affects some of the highest profile names. Johnny Cueto, Garrett Richards and Taijuan Walker have all gone under the surgeon’s knife this year.

It is not only pitchers who are suffering, Dodgers shortstop Corey Seager and Mets catcher Travis d’Arnaud also underwent Tommy John surgery in 2018.

Preseason, Brent Honeywell, Alex Reyes and Michael Kopech were three of the most exciting pitching prospects, but all three have been impacted by the dreaded Tommy John.

Reyes was recovering from UCL replacement surgery he underwent in February 2017. He tossed just four Major League innings this year, before being shut down for the season after tearing a tendon in his back.

Rays’ Honeywell did not even make it through Spring Training after tearing his UCL in February.

The hard-throwing Kopech was just 14 innings into his Major League career before his elbow ligament succumbed to the stress of propelling a ball at 100 mph.

Of course, the biggest loss to the casual MLB fan is that of two-way superstar Shohei Ohtani. The AL Rookie of the Year-in-waiting has mesmerised the baseball world with 20 home runs, .956 OPS and ten starts with 3.31 ERA with a strikeout rate of 10.97 SO/9.

It seems increasingly likely that the 24-year-old will opt for Tommy John surgery in the offseason, ruling him out of pitching for at least the whole of 2019.

There is a good chance that Ohtani will never make ten starts in a campaign again. Even if he does, it is difficult to accept that he will be as devastating as this year. Maybe 2018 was the greatest two-way season any of us will ever see.

Unless alternatives like PRP (platelet rich plasma) injections or stem cell treatment can be proven to be successful, the prevalence of surgery to repair damaged UCLs will remain.

Based on the last 700 pitchers to undergo the surgery, there is an average recovery period of 18 months. This doesn’t include additional time to regain control, velocity or the endurance required to make 30-plus starts.

There seems little enthusiasm in the media to quote realistic return dates. No-one wants to hear that an elite pitcher might be back in 18-24 months with only a 50/50 chance of ever regaining his pre-injury form.

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