03-24-2024 MLB Preview - Flipbook - Page 14
MLB ’24 SEASON PREVIEW
Sunday, March 24, 2024 14
TOMMY JOHN SURGERY ANNIVERSARY
After 50 years, surgery is evolving
to increase success, speed of return
By Ronald Blum
Associated Press
T
ommy John surgery, like
baseball itself, is evolving to increase success and
sometimes speed return. Dr.
Jeffrey R. Dugas developed a procedure that cut recovery time to as little
as nine months for some pitchers with
torn elbow ligaments. He envisions
more innovations within five-to-seven
years. “We’re going to add new levels
of biologic manipulation, whether it’s
collagen or stem cells or things like
that,” said Dugas, who worked with Dr.
James Andrews. “We will be able to
enhance all of these things and potentially make them go a little faster or heal
more reliably.”
In the 50 years since Dr. Frank Jobe ‘s
first Tommy John surgery, the operation
has saved careers and earned fortunes. Los
Angeles Dodgers head team physician Dr.
Neal ElAttrache estimates 80% of pitchers return to their prior performance level.
Tommy John surgery has been
performed on pro baseball players more
than 2,400 times, according to data
collected by baseball researcher Jon
Roegele. More than half of those operations have come in the last 10 years.
“Right now, we’re trying to do whatever we can to respond to the the massive
increases in demand on this ligament,”
ElAttrache said. “Velocity is the main killer.
But right there with it and maybe even
rivaling velocity as the killer of the elbow is
the new emphasis on spin rate because, as
the as the fastball velocity has gone up, the
pitch that fools these world-class hitters is
the offspeed pitch.”
Zack Wheeler had Tommy John surgery
with New York Mets medical director
Dr. David Altchek in 2015 and returned
two years later. He has gone 69-47 since,
becoming a Philadelphia Phillies ace and
signing $254 million in contracts.
“Supposedly, it’s only supposed to last
seven years. You always have that in the
back of your mind,” Wheeler said. “But at
the same time, you can’t really worry about
it. You just got to go out and throw.”
Tommy John had the first ulnar collateral ligament replacement surgery, a revolutionary operation by Jobe on Sept. 25,
1974. Jobe took the palmaris longus tendon
from John’s right arm, drilled four holes
in his left elbow and stitched the tendon
through, replacing the torn ligament. John
returned to a major league mound on April
16, 1976, after a layoff of 18 months, 22 days.
TJ surgery got incremental improvments but was largely the same for the
next four decades until Dugas developed
the internal brace procedure — essentially
a repair of the damaged UCL rather than a
full-blown replacement.
Inspired by Dr. Gordon Mackay’s use of
syntheticsupportingtapeforankleligament
repairs in Scotland, Dugas tested the procedureonelbowsusingcadaversfromArthrex
inNaples,Florida.Heplacesapairof3.5mm
(⅛-inch) Polyether ether ketone (PEEK)
anchors with collagen-coated FiberTape
suture to anchor the damaged ligament.
The repair sped recovery over replacement surgery because there was no time
needed for ligamentation — the process of
the tendon transforming into a ligament.
Seth Maness became the first pitcher
back in the majors following the pioneer
operation after just just eight months, 27
days, in 2017.
“I was all in, and I’m glad I did it,”
Maness said.
Mark Johnson, a rising senior lefthander from Carroll High of Ozark,
Alabama, was the first patient for the new
procedure when Dugas operated on Aug.
8, 2013. He returned to pitch during his
senior season. Dugas earlier had operated
on Johnson’s shoulder capsule and ulnar
nerve.
“I was kind of like the perfect candidate
for it because if I had regular Tommy John
surgery done, that would put me out from
being able to play my senior year,” Johnson said.
While he was on the mound for his
team’s 2014 opener, Johnson didn’t go on
to college ball.
Maness had the initial procedure among
big leaguers with St. Louis Cardinals head
team physician Dr. George Paletta. He
made eight appearances with a 3.72 ERA
in 2017, became a Triple-A All-Star in 2019
and then retired after last pitching at age 31.
“I was very intrigued with it. I didn’t
know a lot about it. I had never heard about
it, honestly,” said Maness, now in his first
season as pitching coach at UNC Greensboro. “Looking back, everybody always
asks: ‘You wish you would have had the
regular Tommy John surgery? And I
really don’t. I came back in a short amount
of time and my arm felt great. I never threw
hard as it was and kind of just got weeded
out.”
Now, the operations have been merged.
Texas Rangers team physician Dr. Keith
Meister combined traditional TJ ligament
replacement with the internal brace, what
is known as a hybrid procedure. Among
his success stories is Tyler Glasnow, who
is set to pitch on opening day for the Los
Angeles Dodgers.
“His theory is that players are throwing so much harder, with also so much
spin, that they are putting so much stress
on that ulnar ligament,” Altchek said. “He
thinks the failure rate is creeping up — we
just haven’t proven it statistically yet —
and therefore adding this synthetic strong
suture will protect the the reconstruction
over time.”
That was the procedure ElAttrache
undertook with two-way star Shohei
Ohtani last Sept. 19 — the Dodgers were
confident enough in the repair to give
Ohtani a record $700 million contract
months later.
“The theory is that the internal brace
suture and the repaired native ligament
will share the load of the new graft as the
graft is maturing,” ElAttrache said. “And
so you have you have increase in strength.
And we think that it’s going to reveal itself
to be increased longevity.”
Better healing is a goal rather than a
shorter layoff.
Rehab usually involves no throwing for
four-to-six months — longer for a second
operation — then two months of long toss.
That is followed by six weeks of pitching
on flat ground or partially up a mound, the
choice depending on team or pitcher.
Biomechanical sleeves measure muscle
strength through torque values.
“If anything, the trend over the last few
years has been to slow things down,” said
Kevin Wilk, the American Sports Medicine Institute’s director of rehabilitative
research. “The thought is maybe the longer
we go, maybe it’ll mature the graft more.”
Innovations such as laser therapy and
Piezoelectric therapy stimulate tissue healing by promoting the release of nitric acid,
which causes blood vessels to widen. Blood
flow resistance is another technique.
“It sounds crazy,” Altchek said. “You
put a tourniquet on the arm, you blow it
up to a certain percentage of the patient’s
blood pressure, cutting off part of the blood
supply and then you exercise in that range
for 10, 15 minutes, and then you let the tourniquet down. ... The local muscles actually
release hormones in a fight or fight way and
it stimulates healing.”
Associated Press Jay Cohen
contributed to this report.