LOS ANGELES ó Tommy John surgery is all too common for pitchers in this day and age. Pitchers of all ages can be stopped in their tracks due to sharp pain in their elbow from the violent action of throwing a baseball repeatedly off a mound.
If the ulnar collateral ligament is damaged badly enough, reconstruction surgery takes place. The operation was pioneered by Dr. Frank Jobe in 1974 when he performed it on Tommy Johnís elbow.
Incredibly, John came back to the Major Leagues in 1976 and went on to pitch until 1989 at the age of 46.
At the time, Dr. Jobe gave John a 1 in 100 chance of ever pitching again in the Major Leagues because no orthopaedic surgeon had ever attempted such a procedure.
In the 38 years since, thousands of Tommy John surgeries have been performed by surgeons across the USA as the entire process, including a 12-15 month rehabilitation, have become refined to the point where 85-90 percent of the time it is successful with pitchers who undergo the entire process for the first time.
Dr. Lewis Yocum of Los Angeles is one of the top orthopaedic surgeons on the world when it comes to this procedure and learned a great deal from Dr. Jobe in his training. He is a Board Certified Orthopaedic surgeon and senior associate at the Kerlan-Jobe Orthopaedic Clinic in Los Angeles. He is entering his 33rd season as Medical Director/Orthopaedist with the Los Angeles Angels.
This skilled surgeon was named by USA Today as one of the 50 most influential people in baseball during 2007. He also has served as President of the Association of Professional Baseball Physicians.
Dr. Yocum was contacted by Collegiate Baseball to ask him a number of specific questions about the entire process that goes into Tommy John surgery, including how to diagnose a serious elbow problem, how Tommy John surgery is performed today along with vitally important recovery and rehabilitation techniques. The following is a special question and answer session with this world class surgeon.
COLLEGIATE BASEBALL: Dr. Jobe pioneered Tommy John surgery in 1974, and it involved a 4-hour procedure on an operating table. I understand that surgery now has evolved so that typically a 1 Ĺ -2 hour procedure takes place involving out-patient surgery.
DR. LEWIS YOCUM: Dr. Jobe was faced with helping Tommy John who had a significant elbow injury at the time. One of the stabilizers in his elbow was torn. Prior to that, guys with elbow problems simply faded away or retired. They simply couldnít do anything about it. Dr. Jobe was smart enough to realize that there may be a way of reconstructing that ligament.
CB: Explain what that first surgery was like and how it has advanced over the last 38 years.
YOCUM: It was definitely a heroic venture by Dr. Jobe back then. It was something that had never been tackled or even contemplated before. The concept of taking a tendon and making it into a ligament had been done by hand surgeons for problems with fingers in the past. But it had never been done to reconstruct an elbow ligament ó especially in a throwing athlete. To get a pitcher back to the Major League level was an amazing achievement by Dr. Jobe. As with any pioneer in surgical procedures, he came up with a reasonable solution. He adopted techniques used in other areas and tried to come up with something that would work. He was fortunate to have a great patient and great technique. The initial surgery on Tommy was about four hours long. Now it takes about 1 Ĺ -2 hours to perform surgery and is done on many occasions on an out-patient basis with people being released the same day.
CB: What is the success rate for those who undergo Tommy John surgery?
YOCUM: It is an 85-90 percent success rate with the operations. This usually involves someone who has had no prior problem, injuries or surgeries before. Patients have to understand that the surgery is not 100 percent successful.
CB: How vital is the rehabilitation once surgery is finished? Several prominent orthopaedic surgeons have said following a specific and highly structured rehabilitation protocol is essential in coming back properly.
YOCUM: Rehab is an important factor. There is an intangible number of individuals involved in getting the pitcher back to the field. Regardless of who is doing the surgery, we have no idea why it doesnít work in some instances. Iím sure it has something to do with the subtleties of the demand of what pitchers do in trying to throw a baseball seven days a week at a high velocity in a highly accurate fashion. Technically, everything can go very well during surgery. But the pitcher may not be able to perform.
CB: How long have you been an orthopaedic surgeon, and how many Tommy John surgeries have you performed over the years?
YOCUM: Iíve been doing this for 35 years since Iíve been working with our group and 33 years with the Los Angeles Angels. I donít know the exact number of Tommy John surgeries I have performed over all those years, but Iím sure itís in the thousands.
CB: If a pitcher experiences constant, sharp pain in his elbow when throwing, what should he do medically as a first step? I realize that some surgeons order X-rays while others want an MRI performed to show precisely what damage has been done to the elbow.
YOCUM: The first step is having an adequate and accurate history. You, as the surgeon, must talk and communicate with the patient to find out what they are talking about. It is easy to distinguish sometimes between muscle strains and ligament problems. The classic Tommy John patient will present subtle abnormalities on an X-ray. But it is very, very rare if they pull off a little piece of bone or something like that. You can do stress X-rays. But the gold standard is definitely an MRI (magnetic resonance imaging) to try and determine the status of the ligament and if it is torn.
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