Do Your Jobe
Frank Jobe never logged an inning of work as a professional baseball player. Never played in the big leagues or even the minor leagues. Yet there is a strong belief among some baseball insiders that Jobe should be in Cooperstown as a member of the Hall of Fame. But again, he never played an out of professional baseball. He wasn’t a writer, manager, broadcaster, etc. In fact he’s a decorated veteran for his time served in the Army during World War II. After his service, Jobe went to medical school and became an orthopedic surgeon. Jobe is credited with saving and extending the careers of numerous pitchers in baseball.
On September 25, 1974 Jobe performed a groundbreaking surgery on Tommy John. At the time, John was in the midst of a solid season with the Dodgers, but damaged his ulnar collateral ligament (UCL). Dr. Jobe would fix John’s elbow by removing a tendon from his right forearm and using that to replace the damaged ligament in his left elbow. At the time there was no belief that John would be able to pitch ever again. He was 31 years old at the time of the surgery and knew he would miss the entire 1975 season. Right after the surgery Jobe believed John had a 1% chance of ever pitching again.
As John slowly was able to use his pitching arm more and more, he eventually started tossing a baseball around and worked towards finding a new delivery on the mound. John made his return to major league baseball and the Dodgers and managed to win 10 games in his return season in 1976. That was considered a massive success at the time, given the injury he had. Not only would he return to form, but he’d go on to win more games after surgery than before. All in all he played from 1963-1989. He won 288 games and collected over 2,000 strikeouts. Unfortunately both Frank Jobe and Tommy John remain outside of Cooperstown, but there’s no denying the impact these two men and this surgery has had on the game. What was once a procedure that Jobe believed would give John a 1% chance to play baseball again now is viewed as one of the most advanced procedures in sports and it gives players a second chance.
The Actual Procedure
The procedure is better known as ulnar collateral ligament reconstruction. The act of throwing a baseball is such an unnatural motion for the body and it often results in a lot of strain on the elbow. It’s not clear whether the amount of pitches thrown or how hard a pitcher throws is the indicator for UCL damage. Typically a ligament will tear even if it’s stretched six percent beyond its normal length. Pitchers like Justin Verlander and Chris Sale have thrown very hard in their careers, but neither has required surgery. Some believe the amount of pitches thrown (typically in a player’s youth) tends to lead to the surgery. How about pundits settle on this: Every human being is different. No athlete is the same as another. The wear and tear on one pitcher can differ from another. Injury time frames differ as well. Adrian Peterson is an absolute freak of nature and recovered from a torn ACL faster than no other. So while Tommy John surgery is surging in popularity there will be some players that just don’t require it. And some players that skate by will throw harder and more often than others. There are always outliers. But it’s no surprise that the procedure is most common in baseball players because the throwing angle is so unorthodox.
For those that do suffer UCL damage the process is simple. In the above image on the left is a pretty standard graphic of what a human elbow looks like. The UCL holds the humerus and ulna bones together. Over time the UCL becomes damaged through the pitching motion. When the UCL needs to be repaired, surgeons will make a three-to-four inch incision by the elbow and drill holes like the ones in the image on the right. Surgeons will also remove a tendon from a forearm or leg to replace the damaged ligament. Tendons are good replacements for ligaments because they’re similar but serve different purposes in the body. Tendons connect muscle-to-bone while ligaments connect bone-to-bone.
Now in the image above lies the final product. The tendon is weaved through the drilled holes in the ulna and humerus bones in a figure-eight pattern. Then the original incision is sewn up and a brace is applied to stabilize the elbow for approximately six-to-eight weeks. As previously mentioned the recovery window for a pitcher is typically 12 months, which is pretty arduous, but pitchers are pretty damn happy when they can resume throwing activities. Just see Joba Chamberlain’s tattoo/Tommy John scar below.
To Trust or Not to Trust the Process
Committing to the surgery is a big decision. A lot of time with pitchers in the current landscape of professional baseball it’s not so much a question of if a pitcher will undergo TJ, but when will they opt for the surgery? Since the surgery’s inception there have been over 1,400 players from pro ball and college to opt for Tommy John surgery. The original surgery was in 1974 and Brent Strom’s was next in 1978. The surgery didn’t start gaining traction until the 1980’s. Tampa Bay Rays prospect Brent Honeywell is the latest pitcher to succumb to the surgery as the news dropped just last week he’d be going under the knife to repair his torn UCL. It’s a long road back, but the surgery can be successful for some pitchers.
Prior to his tragic death toward the end of the 2016 season, Jose Fernandez was on a clear path to being one of the pitchers to bounce back from Tommy John surgery. Fernandez burst onto the scene in 2013 with a 12-6 record and winning the National League Rookie of the Year award. In 2014, after recording 70 strikeouts in 51.2 innings of work, he was placed on the disabled list with a right elbow strain. Later on it was revealed he had partially torn his UCL and that he would need Tommy John surgery. He required a 14-month recovery window, but returned to form in July of 2015. He did experience some setbacks during his 2015 season, but the 2016 season proved he had a full recovery from the surgery. In 29 starts he compiled a 16-8 record with a 2.86 ERA and a 12.49 K/9. Most notably he didn’t really lose any velocity with his fastball. He still managed to average a 95-96 mph heater while still mixing in his slider, curveball, and changeup efficiently. Unfortunately for Fernandez his season, career, and most importantly, his life ended far too soon.
Yu Darvish is another well-known pitcher that has bounced back from Tommy John surgery. Darvish, like Fernandez, required 14 months from the time he underwent the surgery to when he was able to make his next start. Since the surgery Darvish has done very well. Dating back to 2016 he’s thrown 287 innings with 341 strikeouts. Darvish’s velocity has actually increased since his surgery. In 2014, the year before his procedure, his fastball averaged 92.4mph. In 2016 it rose to 93.3mph and last year in 2017 his fastball averaged 94.2 mph.
Now to argue what “a successful return from Tommy John” means is really just arguing semantics. For Tommy John, success was just returning to pitch again in the big leagues. Winning 10 games after returning, and then going on to having a very long career was considered an absolute miracle. But while most players return from the surgery and some regain their form, others aren’t as fortunate.
Matt Harvey underwent Tommy John surgery and obviously missed the entire 2014 season. But he did return and find some success in 2015 with a 13-8 record and a 2.71 ERA. But there were differences between how much work the Mets wanted to give him that year and the recommended workload from Dr. James Andrews and Harvey’s agent. Now Matt Harvey certainly hasn’t returned to form. In 2017 he wasn’t even able to throw 100 innings and he sported a brutal 6.70 ERA, 4.56 BB/9, and surrendered 2.04 HR/9. His fastball lost two miles per hour over the last two seasons and he’s currently trying to reinvent himself as a pitcher.
Matt Moore also hasn’t been able to fully return to form, much like Harvey. Moore had the procedure in April 2014. This was an unfortunate series of events for Moore. He was coming off a 2013 season with a 17-4 record and an All-Star appearance. He was everything the Rays thought he would be and then he was derailed by this surgery. His control hasn’t necessarily gotten better and after being traded to San Francisco he hasn’t seen much success on the West coast. Not even a change in scenery to one of the most pitcher-friendly ballparks in baseball could help Moore as he had a 5.52 ERA with San Francisco in 2017.
Tommy John surgery isn’t a guarantee. Even back in 1976, Tommy John himself had to work with teammate, Mike Marshall, on developing a new pitching motion that would take pressure off his knee and elbow. It’s not a sure thing that a pitcher will get back to 100%. There are plenty of cases proving pitchers can come back and rejuvenate their career, but there are some pitchers that don’t fully come back as unfortunate as that may sound.
Impact on Other Positions
Pitchers aren’t the only baseball players prone to Tommy John surgery. While they represent a vast majority of participants in this particular procedure, positional players occasionally get in on the action. More recently, one of the New York Yankees top prospects, Gleyber Torres, had UCL reconstruction in 2017. Now the recovery process for positional players is a lot different than it is for pitchers. Because pitchers require a very unique way of delivering the ball that invites tension on the elbow, they have to take their time with recovery. Positional players are different. The recovery time is nearly half of what it is for pitchers. Although Torres is outside the six-month recovery window it’s still likely that he could miss the start of the 2018 season if New York wants to play it safe and make sure their top prospect is ready.
If pitchers are the most popular candidates for Tommy John surgery, then catchers are a close second… Alright so it’s not close. Catchers are more of a distant second given that there are so many pitchers that need this surgery. But regardless catchers are pretty popular as well. It makes sense. Defensively they’re required to try and throw out runners attempting to steal a base and that requires a quick release. Again, this is tension on the elbow. Christian Vazquez of the Boston Red Sox had UCL reconstruction and missed the entire 2015 season. Now he had some setbacks in 2016, but in 2017 he did log 345 plate appearances and a .290 batting average. The power numbers weren’t great, but he did throw out 42% of runners while the league average for catchers was 27%. So while he’s not an elite hitter he’s returned to defensive form.
Miguel Sano is another positional player who has undergone Tommy John. To be fair, Sano underwent the surgery a year before he made his first big league appearance. So while it only pushed his debut back a year there aren’t big league numbers to compare his post-surgery numbers to. Alas, even after the surgery his numbers are very good. He has a career .254 batting average over three seasons, but he does have a .496 slugging percentage and he’s increased his home runs each season he has played. While Tommy John hasn’t hindered him as a hitter, Sano is worth monitoring because he hasn’t logged 500 plate appearances or 120 games played in a season so far.
Like pitchers, there are some positional players that haven’t fared too well post-Tommy John surgery. Matt Wieters had it in 2014 and although he was an All-Star in 2016, his batting average, on-base percentage, and slugging percentage have decreased each year since 2015. Likewise Carl Crawford joined the Tommy John Club in 2012. After being traded from the Red Sox to the Dodgers, he was able to get off to a decent start in L.A. but gradually accrued more injuries as time went on.
Tommy John surgery offers no guarantees, folks. It’s worked out very well for players in the past, but don’t expect the same results for everybody.
Take it From One of Fantasy Alarm’s Very Own
Fantasy Alarm’s very own, Justin Vreeland, has actually undergone Tommy John surgery before. Out of high school, Justin went to Florence-Darlington Technical College, a junior college with a great baseball program. Two weeks into his time at school he tore his elbow and required UCL reconstruction. After talking with Justin, here’s what he had to say about the mental aspect of recovery:
“Going through the process I can tell you it was very strenuous and it’s not just the physical side (most people understand that portion of it) but what is missed is the mental side of it. Even though you trust the surgeon and you know the surgery went well and every checkup you are being told it is healing perfectly and such, its still so difficult to not let negative thoughts creep in. Each workout in the gym, each throwing session, each rehab session there is that thought of "maybe it isn’t right, what if it tears again?" It took me being fully back and pitching in regular season games on a regular basis to crack those fears. Even the slightest bit of natural soreness that pitchers go through worries you. Then on top of that you have to watch your teammates all playing the game while you’re on the sidelines recovering and that is another hard part in its own. One of the biggest positives that comes out of the whole process (aside from being back to health and returning to the mound of course) is the extra appreciation you have for the game. Being able to do the little things of just even being able to have a pain-free toss are things you wouldn’t ever think about before the injury but post-op you really appreciate it…
Also, people don’t understand the actual pain you are in when it’s torn. It’s literally awful. I walked off the mound my last time before going under the knife in tears holding my elbow up with my other arm in excruciating pain. It’s like someone is stabbing you in the elbow. “
Major League Baseball players have access to top doctors and training staffs, as well as advanced forms of therapy to recover in 12-14 months. Justin’s recovery took a little bit longer. His took about 18-24 to fully be able to pitch with confidence and no fear of re-injuring his elbow. Once fully recovered Justin was able to pitch two seasons at Claflin University where he earned All-Conference and Pitcher of the Year recognitions.