Sims: Astounding Number of Tommy John Surgeries in 2012

31 Pitchers Underwent Tommy John Surgery in 2012

WCBS-TV—September 21, 2012

An astounding thirty-one major league pitchers underwent Tommy John surgery in 2012 and another, 40 year-old Jose Contreras, was diagnosed in June with a tear of the ulnar collateral ligament (UCL) and flexor pronator in his throwing elbow.

The ulnar collateral ligament is the primary stabilizer of the elbow. Pitchers place undue stresses on the medial (inner) elbow, and this excessive loading of the region can impact not only the UCL, but can also create inflammatory conditions in all of the structures in the area. The repetitive demands of pitching and the nature of the motion itself – particularly the acceleration phase – are the primary culprits.

Dr. David Altchek, orthopedic physician for the NY Mets, and co-chief of the Sports Medicine and Shoulder Service at New York’s Hospital for Special Surgery, pioneered a radical modification of the Tommy John procedure that is now the gold standard. The original surgery, first performed by Dr. Frank Jobe in 1974 on Tommy John, then of the LA Dodgers, involved using a tendon graft harvested from the patient and weaving it in a figure eight pattern through channels created by drilling three holes into the bone.

To do so, muscles were detached and the ulnar nerve had to be moved. The newer technique, known as the docking procedure is less invasive, entails splitting the muscles rather than detaching them, requires that only one hole is drilled and allows the ulnar nerve to remain in place. Success rates exceed that of the traditional approach, though pitchers still are progressed cautiously and on average return to competition just prior to the anniversary of surgery. Success is determined by restoring pre-injury levels of performance rather than time to return.

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