Is Tommy John surgery being overused?

Por Alfredo Alvarez

Miami — Every day, millions of dollars are invested in the search for golden arms in baseball. Senior organizations prioritize pitchers, both in the College and International Drafts, so the MLB franchises need to be sure that their investment lasts the entire time of the contract.

In recent years, there has been an increasing number of players, especially pitchers, who undergo the Tommy John operation.

What is a Tommy John operation?

The famous operation was born in 1974, when the famous pitcher of the Los Angeles Dodgers, Tommy John, had the first reconstruction surgery of the ulnar collateral ligament at the hands of the now defunct Dr Frank Jobe, who was the team’s doctor at the time, and named the surgery after his patient.

The procedure is simple; the band of connective tissue that makes up said ligament is replaced with a tendon that comes from another area of ​​the patient’s own body or from a donated corpse.

After the successful surgery, pitcher Tommy John returned to pitch in 18 months. His rehabilitation and successful recovery allowed other pitchers to submit to the process, although many young people in those times avoided it because of their long healing time.

In the mid-70s and 80s, it was rare to see players undergo Tommy John surgeries. But as baseball has evolved, today’s pitchers increasingly throw harder and on the other side the hitters who face them are getting smarter and stronger. To this we add what these athletes are worth, and the result is almost a fashion or trend, something so common that it no longer surprises.

«The Tommy John» is already a well-known phrase and widely heard daily. The statistics show us that in total there are 309 operations to date. The biggest boom was seen from 2005 to 2015, where there was an average of 84 surgeries per year. However, from 2016 to 2018 the average dramatically dropped to about 25 per season.

Why was this happening?

Many researchers believe that this drop in TJ surgeries is due to the increase in stem cell therapy as an alternative musculoskeletal treatment. Baseball players (especially pitchers) have begun quietly undergoing therapies not so invasive or painful to recover their arms from injuries.

In 2014 Yankees right-hander Masahiro Tanaka suffered an injury in which he was initially diagnosed with a partially cracked ulnar collateral ligament, so Operation Tommy John was suggested. However, Tanaka and his medical team refused to use the invasive procedure and used an injection of platelet-rich plasma, with which the pitcher miraculously returned in 6 weeks, and continued his career in the majors for 4 more years.

Other cases occurred in 2016, when Angels pitchers Andrew Heaney and Garrett Richards underwent a new form of treatment for arm pain: stem cell therapy. This was the first time that baseball players and their organizations admitted to having tried this new cutting-edge procedure. The successful rehabilitation of Heaney and Richards proved that stem cell therapy, like platelet-rich plasma injections, helps major leaguers avoid Tommy John surgeries.

The most recent case is that of another star from the land of the rising sun: Shohei Ohtani, who was placed on the disabled list with a sprain of the ulnar collateral ligament on June 8 and was rumored to undergo Tommy surgery. John missed the rest of the 2018 season, but it was not like that. Ohtani received his treatment of plasma injections rich in platelets and stem cells and is already launching bullpen sessions and everything, slated to return to the mound in a few weeks. With these examples raised above, I cannot help but ask myself these questions:

Why is this operation suggested so lightly? Why not treat these processes before reaching for the scalpel?

The reasons vary from not taking risks, to the high value of an athlete today, to the doctors themselves who may want to charge more money for more invasive processes. In short, the positive part is that little by little, it seems that the future is heading towards the disappearance of this operation, which, although it has helped many players and was a great invention in the 70’s, also brings with it a too-long recovery.

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