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Understanding the Risks of Tommy John Surgery

November 21, 2016

For many athletes, sometimes recovery can be as trying as the initial injury.

That’s likely the case for Matt Harvey, the All-Star New York Mets pitcher who recently returned to the field after Tommy John surgery. 

Harvey missed all of the 2014 baseball season to recover from Tommy John surgery, an operation that aims to correct a torn elbow ligament. Named after former Major League Baseball (MLB) player Tommy John, who is considered one of the best left-handers in baseball history, the surgery has become more common among professional baseball players. Last year, 31 MLB players underwent Tommy John surgery, with 11 undergoing revision procedures, according to ESPN.

Though Harvey has performed well since his return, pitching results in tremendous forces on the elbow, making it unknown how long he still can play at peak performance even after surgery. Our own research has found that the Tommy John surgery will typically result in successful short-term and long-term outcomes; however, some baseball players may experience suboptimal results, with some returning to play at a lower level than before surgery while others have undergone second operations to continue their athletic careers.

In addition, the surgery is a major procedure that necessitates a long recovery, so if you’re considering this surgery it’s important to weigh all the benefits and potential risks beforehand.

What We Know About Tommy John Surgery

In the 40 years since Tommy John surgery first emerged, 488 major and minor league baseball players have undergone the procedure.

Tommy John surgery is common among pitchers because the initial injury occurs after repetitive, forceful movements of the elbow, which are very typical at this playing position. During the operation, which also is known as ulnar collateral ligament (UCL) reconstruction, doctors replace the torn ligament in the elbow with a tendon from another part of the body. Rehabilitation can take anywhere from 12 to 15 months.

The decision to undergo this surgery is a personal one for many players, and it’s often based on the nature of their injury and their doctor’s recommendation. But in recent years, several misconceptions have developed around Tommy John surgery: that it always leads to successful outcomes and that it actually enhances player performance.

However, this isn’t true. We often hear about the success stories and miraculous comebacks after this procedure, but we also need to broaden the conversation and include cases at the other end of the spectrum. For example, Joey Devine, a relief pitcher for the Oakland A’s, took two years to recover from Tommy John surgery. He re-injured himself and had a second surgery in 2012, but hasn’t played since. Harvey’s teammate, Jeremy Hefner, also underwent two surgeries, as did former Rangers’ pitcher Joakim Soria. In all, 46 players have had at least two of these surgeries. 

What to Consider Before Deciding on Surgery

Tommy John surgery is not a cure-all for an elbow injury. Though this procedure has a success rate of between 80-85 percent, in some cases players may achieve a lower performance level after surgery. In fact, sometimes conservative or non-surgical approaches work best for treating elbow ligament injuries. Masahiro Tanaka, the starting pitcher for the New York Yankees, was diagnosed with a small UCL tear last summer and has slowly recovered after taking two months off and using platelet-rich plasma injections to heal the ligament. So far, he’s played at a high level (the New York Times recently called his performance stellar).

Depending on the size of the ligament tear, delaying surgery may or may not be the best approach and requires a thorough discussion concerning the injury, past injury history, seasonal considerations, and future career aspirations. Either way, it’s important to talk to your doctor and explore all possible options. Tommy John surgery has excellent success rates, but rehabilitation can be a lengthy process, which ultimately makes the decision making process the most important step in the athlete’s injury recovery.