Tommy John Surgery: Major Surgery

Laser eye surgery has become a pretty routine procedure. Nothing’s yet been perfected, and fear comes from a machine slicing your eyes open, but patients are in and out in practically no time at all, and the risk of complications is incredibly low. And many of those complications are minor and/or temporary. It’s a safe and accepted part of contemporary living. Given that it involves removing tissue from one body part and weaving it into another, it’s something of a miracle that Tommy John surgery these days has a success rate even within sniffing distance of laser eye surgery. Of course, it’s not that automatic, and of course, there’s still the year-long rehab, but Tommy John surgery isn’t feared the way it used to be, and the results tend to speak for themselves. Certainly, among fans, it seems like the operation is simply seen as a year-long delay. Less devastating, more annoying.

To an extent, that’s justified. Surgeons know what they’re doing, the rehab track has been tested a million times over, and most pitchers are able to make it back and make it back effectively within the usual timetable. Sometimes they even feel stronger, perhaps because other parts of their bodies are able to heal while the pitcher isn’t throwing. But it’s important to understand that there can be speed bumps. Sometimes there can be even bigger obstacles. Recovery from Tommy John shouldn’t be taken for granted, and you could just ask Cory Luebke.

Ever so quietly, Luebke went about establishing himself as one of the more promising starting pitchers in the National League. He started 17 times for the Padres in 2011 and allowed 39 runs, with four strikeouts for every walk. He came out in April 2012 pitching similarly well. At the end of that same month, he underwent Tommy John surgery.

As usual, it was expected that Luebke would be able to return early in the 2013 regular season. What actually happened was that Luebke made zero appearances. He experienced several setbacks during his effort to get back to the mound, and just the other day, it was announced that Luebke needs Tommy John surgery again. The Padres expect him to take about a year, again. They feel pretty confident in the timetable, just like last time.

The Luebke situation has been a disappointing mess, but it also hasn’t been an isolated event. Anecdotally, it feels like we’ve seen a greater number of pitchers than usual struggle during their Tommy John rehabs of late. It doesn’t mean the surgery has somehow gotten more dangerous or less effective, but Luebke isn’t the only reminder that ligament replacement surgery is still a pretty big deal.

Last summer, Daniel Hudson was working his way back from Tommy John surgery. He was sent out on a rehab assignment, and shortly before he was brought back by the Diamondbacks, he came down with some elbow stiffness. Examinations revealed that Hudson needed another Tommy John surgery, having re-torn his ligament. He’s on the way back again.

Brandon Beachy was incredible. Remember Brandon Beachy? He had Tommy John surgery in the middle of 2012. He managed to return to the Braves on time with little particular difficulty, and he turned in a few decent starts, but then his elbow started barking and he had to be shut down. He underwent an arthroscopic procedure for cleanup purposes, and now he’s looking to be healthy for spring training.

There’s Scott Baker, who had Tommy John surgery in March of 2012. Last offseason, the Cubs signed him to a one-year contract in the hopes that he’d bounce back and they’d be able to flip him for prospects around the deadline. That isn’t what happened. Instead, Baker experienced setback after setback, and he made his 2013 debut in September, throwing with diminished velocity.

Ryan Madson was a similar kind of case. He had Tommy John surgery at the end of March 2012. Last offseason, the Angels signed him to a one-year contract, in the hopes that he’d bounce back and be able to help a competitive team’s bullpen. That isn’t what happened. Instead, Madson experienced setback after setback, and he was released in August having not appeared in the bigs. He’s throwing now, looking for an employer.

It doesn’t end there. Joel Zumaya hasn’t been heard from since Tommy John surgery early in 2012. Joey Devine also hasn’t been heard from since Tommy John surgery early in 2012. Felipe Paulino had issues returning to the mound, although there were complications with his back and shoulder that might have been unrelated to what happened with his elbow. But the common thread is that a bunch of guys had Tommy John surgery and they’re still today looking to get back to what they were. Not one of these pitchers followed the timetable that we’re so happy to just take for granted. Of course everyone’s always warned that there can be issues and delays, but it seems like the actual probabilities aren’t sufficiently appreciated.

Tommy John surgery isn’t shoulder labrum surgery, and the surgeons who perform it know the procedure like the backs of their hands. But it’s not just a 12-month delay, even if that’s maybe the most usual outcome. There can be setbacks, and there can be major setbacks. Ligaments can be re-torn. Elbows can otherwise need to be re-opened. Of course it’s never good news when a pitcher requires ligament replacement surgery, but on top of the loss of a year, there can be a loss of a lot more than that.

I’ve got no idea how the pitchers above are going to do going forward. Many of them should return to the majors, and they could be successful if and when they’re ever healthy. The Braves will be counting on Beachy, and the Diamondbacks made a point of re-signing Hudson. The Mariners scooped Baker up and the Padres will look forward to having Luebke whenever that is. Maybe they’ll simply have missed a little more time. But in each case, recovery went awry, and it’s too easy to forget that that can happen.

Tommy John surgery was one of the most significant developments in baseball in the 20th century, and it’s helped to save so many virtually countless careers. It really has gotten to the point where a lot of fans simply take the procedure and the recovery for granted. That speaks volumes about the effectiveness of the operation and the people doing it, but ultimately, it’s still surgery, and it’s still pitching. Tommy John surgery is great. Elbows and shoulders suck.




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Jeff made Lookout Landing a thing, but he does not still write there about the Mariners. He does write here, sometimes about the Mariners, but usually not.


29 Responses to “Tommy John Surgery: Major Surgery”

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  1. Gricomet says:

    I think it is good to point out that Tommy John surgery is a significant surgery and recovery is not automatic, however I’d really prefer a comparison rate of successes to failure or delays. 8 recent failures/set backs sounds bad but how does that compare to the total number of surgeries done?

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  2. Guest says:

    Has there been a recent wave of different doctors performing them in comparison to years past?

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    • cass says:

      I wonder about that too. Dr. Yocum died last year, though that might be too recent to explain the trend. But I don’t remember hearing about any troubles with his patients, only a number of success stories like Strasburg, Zimmermann, and (it seems like so far) Giolito.

      I’d be interested to know who the doctors were for the players Jeff Sullivan talks about, though of course there are more people involved in the rehab.

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  3. Adam says:

    Shockingly, there’s very little data on this in the medical literature.

    Here’s two cohort studies that you can take a look at:

    http://ajs.sagepub.com/content/early/2013/12/17/0363546513510890.abstract

    http://www.sciencedirect.com/science/article/pii/S1058274613000888

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    • Snarf says:

      “Rate of Return to Pitching and Performance After Tommy John Surgery in Major League Baseball Pitchers”

      Pitchers returned to the MLB at a mean 20.5 ± 9.72 months after UCL reconstruction.

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  4. Billy says:

    Yeah, I’m thinking the number of pitchers who had Tommy John and are never the same may not be all that much more proportionally than the number of healthy pitchers who get hurt and bust. Then again, as I type this, I’m thinking Sullivan thought of that himself and would have said as much if it were the case.

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  5. ChuckO says:

    One thing that seems to have changed is the rehab time. It used to be 18 months. Now you see guys coming back after 12 months. It may be that this is too soon for some. Another thing we don’t know about is how diligent those whose surgeries failed were in the rehab process. It is said to be grueling. It wouldn’t surprise me if some pitchers fail to follow it like they should.

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  6. Nick says:

    Edit needed? Looks like the last line was omitted. Should read:

    “But Matt Harvey is going to be fine. Just fine, fine forever.”

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  7. Hurtlockertwo says:

    I would submit you are never “perfectly normal” after a major surgery. Even young children that have surgery do well initially and have issues later in life. Surgery is traumatic, from the Anesthesia, to recovery and then rehab. Like the old saying says, the only minor surgery is done on someone else.
    TJ surgery has two surgical sites and often movement of the ulnar nerve, all very traumatic.

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    • Lanidrac says:

      I wonder how often the corresponding missing ligament in the knee after the surgery becomes an issue later in life, although the surgery may still be too new for us to have significant data on that.

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  8. Rawson Baggs says:

    Rangers’ Neftali Feliz missed a year and a half.

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  9. Daneeka says:

    As someone who very recently underwent Tommy John, there is real terror associated with the rehab process. The two major points, as Jeff mentioned, are trying to avoid setbacks and be the same pitcher once you recover. In the rehab process, there isn’t room to consider the latter, because it feels impossible. Your arm isn’t your arm anymore, and seems to be constantly on the brink of being reinjured. Of course, with fandom, there needs to be some reason for optimism, and having the top surgeons and rehabilitation services available fits that bill. There is a thin line between being optimistic and taking the process for granted, though, and in cases like Beachy, Zumaya, etc. it’s important to be aware that while there is cause for optimism, a surgery that is so inherently barbaric as Tommy John is nothing to be taken lightly. So really, spot on.

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  10. chris moran says:

    Thank you for writing this. I’m sick of hearing people talk about how TJ isn’t that big a deal and players will rebound in 9-12 months. The reality is that it’s major, and lots of players return as a lot less than they were. On a related note, Dylan Bundy is ranked far too high in most prospect lists.

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  11. Bob says:

    Kyle Drabek should be one to watch this year as he had his 2nd TJ last year.

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  12. skmd says:

    “it’s helped to save so many virtually countless careers. ”

    almost like the so much virtually awful syntax in that sentence….

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  13. shthar says:

    I’ve found that the pitchers who don’t come back from TJ are the ones on my team.

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  14. freeman says:

    I wonder if the crackdown on PEDS is a possible explanation for the recent lack of success of TJ surgeries (it seems like HGH would be helpful in recovering from such a major surgery)

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    • pft says:

      The HGH testing just started last year and is unlikely to catch anyone since the drug is metabolized so quickly that the detection window is only 10-20 hrs after use. Players can take the HGH right after a game and be pretty sure they will be clean before the next nights game, especially if they use slightly lower doses. In the offseason, or while rehabbing in-season, its much easier since they have 7 days to report for a test.

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  15. Jays says:

    Something I’ve never understood is how Tommy John surgery is OK and even encouraged whereas all performance enhancing drugs are considered completely wrong and immoral. For those who don’t know, Tommy John surgery takes a tendon from you leg and inserts it into your arm. Yes, it puts your LEG into your ARM. Guess which is stronger? There is absolutely nothing natural about this. At least with PEDs, a player is using his natural body unlike Tommy John where it is something completely unnatural. In the future, who knows where this could lead? Synthetic materials giving very unnatural strength?

    I’m not at all condoning PEDs, but I think if the goal is to have baseball be a measure of natural talent, Tommy John is much worse than any drugs out there.

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    • Wobatus says:

      I don’t think having a a leg tendon in your arm enables you to throw any harder or with a greater break than an arm tendon. It may make you be able to throw more often, say 30,000 times as opposed to 15,000 times, without the tendon snapping, but I don’t even know if that’s true. Evidently not for Cory Luebke.

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      • Jays says:

        Your leg is stronger than your arm. Leg tendons are stronger than arm tendons, that’s why they use them. That is beside my point, they could take a stronger or weaker tendon, an animal tendon, or a synthetic tendon, it doesn’t matter. This is still much more unnatural than someone taking PEDs to let their natural body heal faster. It just amazes me how quickly people make up their minds about what is right and wrong without looking at the entire picture.

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      • Jays says:

        Also, using your example, if Roger Clemens took steroids that added 5-6 years to his career, how is that different from someone else having Tommy John surgery, doubling the lifespan of their arm?

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  16. pft says:

    I wonder how much of the problem with TJ Surgery recently is teams rushing back players. I remember when Daisuke and Hill came back from TJ Surgery the Red Sox were trying to get them back in under 12 months, justifying the rush by saying how much more effective TJ Surgery is now. Both of them had setbacks and neither has been the same pitcher they were before TJ Surgery.

    As I argued then, the time limiting factor for TJ Surgery is the time taken for the tendon to turn into a ligament. A tendon has much different physical properties (higher tensile strength, lower elongation to put simply) than a ligament but over time it will ligamentize. Rushing back too soon is a recipe for disaster.

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