The Myths Surrounding Tommy John Surgery

Sommer Hammoud, MD
April 27, 2017

An elbow injury requiring reconstruction of the ulnar collateral ligament (UCL) is one of the most devastating injuries in baseball. Tearing of the UCL typically occurs in pitchers and results in the inability to throw competitively. For significant partial injuries or complete tears of the UCL, surgery – known as “Tommy John” – is often required. 

There are several myths in regards to Tommy John surgery. A survey study by Dr. Christopher Ahmad (1), demonstrated just how prevalent these misperceptions are. In their study, 30% of coaches, 37% of parents, 51% of high school athletes and 26% of collegiate athletes believed that Tommy John surgery should be performed on athletes without injury to enhance performance. Moreover, 28% of players and 20% of coaches surveyed believed that having Tommy John surgery would enhance pitching performance, including speed and control beyond pre-injury levels.  Moreover, 24% of players, 20% of coaches and 44% of parents underestimated the time required to return to competition. They believed that return to play would occur in less than 9 months.  

The public perception that Tommy John surgery will make a pitcher throw faster and improve their control is one of the most common – and no research has ever demonstrated this to be true. The most likely scenario is that the injured athlete slowly loses control and their pitch velocity decreases as the injury to the UCL progresses and becomes more painful. Therefore, after surgery and a full rehabilitation program, the athlete may then feel that they are throwing harder and better (as compared to the injury period). In fact, the rehabilitation phase after surgery takes 12 months or more. It is a comprehensive program for the elbow, shoulder, core muscles, hips and legs, all of which are essential for throwing with maximal control and velocity. Often, the athlete has never devoted such an extensive amount of time to a comprehensive strengthening program and was not optimized prior to their UCL injury. 

Research has demonstrated that players can return to pre-injury performance levels in 80% to 90% of cases after UCL reconstruction (2).

1. Ahmad CS, Grantham WJ, Greiwe RM. Public perceptions of Tommy John surgery. Phys Sportsmed. 2012 May;40(2):64-72.
2. Vitale MA, Ahmad CS. The outcome of elbow ulnar collateral ligament reconstruction in overhead athletes: a systematic review. Am J Sports Med. 2008;36(6):1193-1205.

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