10 Interesting Facts About Tommy John Surgery

Trevor Rosenthal’s 2018 season was derailed due to Tommy John surgery in late-2017. (via Sports Spectrum)

It’s that exciting time of year again! Baseball has started anew, and every fan base is hopeful of a strong season ahead for its favorite team. It’s also a time when many fans are wondering if one of their team’s pitchers is going to make it back from Tommy John surgery.

For the past several years, I’ve kept track of as many Tommy John surgeries as I can in an online spreadsheet. This article serves as an analysis of that data from a number of different angles.

By the end of the 2017 regular season, there were 183 pitchers who had thrown at least one pitch at the major league level and also had Tommy John surgery. In addition, 19 pitchers had undergone the surgery, did not enter any games in 2017, but finished the season on the major league disabled list. Here is the list of these 202 pitchers.

The Dodgers, Giants and Tigers led the way, each using 10 pitchers who have had Tommy John surgery. The Orioles and Red Sox were at the other end of the spectrum, each using only two pitchers in 2017 who’ve undergone this procedure.

In all, 26 percent of major league pitchers used in 2017 had undergone Tommy John surgery.

In 2017, a whopping 86.7 percent of all regular season games featured at least one pitcher who has had Tommy John surgery. The breakdown of this percentage of games by team is shown in the table below.

Percentage of 2017 MLB Games Featuring at Least One Pitcher Who Has Had TJ Surgery
Team Percentage of Regular Season Games
San Francisco 98%
Colorado 98%
Cleveland 97%
Kansas City 96%
New York (NL) 96%
Detroit 96%
Miami 95%
Atlanta 94%
Arizona 93%
Pittsburgh 93%
Los Angeles (NL) 92%
St. Louis 89%
Cincinnati 89%
Los Angeles (AL) 89%
Oakland 89%
Washington 89%
Chicago (AL) 88%
Chicago (NL) 87%
Texas 87%
MLB 86.7%
Philadelphia 85%
Toronto 84%
Houston 84%
San Diego 84%
Milwaukee 81%
Tampa Bay 75%
Minnesota 75%
Seattle 74%
New York (AL) 70%
Baltimore 68%
Boston 65%
Includes games where one pitcher from either team has had TJ surgery

The 2017 game that involved the most pitchers who have recovered from Tommy John surgery was between the San Francisco Giants and Colorado Rockies on June 15.

Ten pitchers who had had Tommy John surgery appeared in that game, including:

The pitchers combined to pitch 17 of the 18 innings.

At five years, the Baltimore Orioles are the team with the longest active streak without losing a pitcher to Tommy John surgery. Here are the most recent surgeries for each team, for a pitcher whose last game prior to surgery was at the major league level.

Most Recent Major League Pitcher TJ Surgery by Team
Team Pitcher TJ Surgery Date
Baltimore Dylan Bundy 6/27/2013
Pittsburgh Brandon Cumpton 3/10/2015
Texas Lisalverto Bonilla 4/15/2015
Detroit Joe Nathan 4/29/2015
Atlanta Andrew McKirahan 3/10/2016
Colorado Jairo Diaz 3/18/2016
Chicago (NL) Manny Parra 4/8/2016
Kansas City Tim Collins 4/15/2016
Boston Carson Smith 5/24/2016
Milwaukee Sean Nolin 8/1/2016
San Diego Colin Rea 11/10/2016
Cleveland Cody Anderson 3/27/2017
San Francisco Will Smith 3/28/2017
Toronto Bo Schultz 3/29/2017
Minnesota Ryan O’Rourke 5/2/2017
Arizona Shelby Miller 5/10/2017
Tampa Bay Shawn Tolleson 5/17/2017
Houston Jandel Gustave 6/21/2017
Chicago (AL) Zach Putnam 6/23/2017
Washington Joe Ross 7/19/2017
Miami Edinson Volquez 8/4/2017
Los Angeles (NL) Grant Dayton 8/29/2017
St. Louis Trevor Rosenthal 8/30/2017
Philadelphia Jesen Therrien 9/19/2017
Cincinnati Drew Storen 9/26/2017
Oakland Jharel Cotton 3/21/2018
Seattle David Phelps 3/26/2018
New York (NL) Rafael Montero 3/27/2018
New York (AL) Ben Heller 4/6/2018
Los Angeles (AL) JC Ramirez 4/17/2018

Tommy John surgery is prevalent enough that I commonly come across fans complaining specifically about their team’s bad luck or seemingly incompetent medical staff. In fact a few years ago, I was able to compile a set of tweets from fans — one for each major league organization — in which the authors weres lamenting how their team was especially hard hit with respect to Tommy John surgeries.

For the most part, this is just a form of bias on the part of fans, who pay far more attention to their own club that any other. Even when there are a couple of surgeries close together on a single team, for the most part I believe this is merely coincidental.

If I had to allow three fan bases the right to complain about the particular Tommy John hardship of their favorite team over a short period of time, it would be the fans of these teams.

TJ Surgery Concentrations in Single Teams
Team Level TJ Surgeries Timespan
Mississippi State Division 1 (College) 7 16 months
Columbia (NYM) A 5 4 months
Nebraska Division 1 (College) 4 11 months

Nebraska has a fifth player with UCL damage within a year, but is still weighing whether to undergo surgery at this point.

Concentrations this strong in a single place could still be just coincidental, but it certainly seems possible something about the training philosophy or implementation of that philosophy in these cases did not go as desired.

Recently, I have been collecting data on certain Tommy John surgery rehabilitation milestones. Of course every athlete is different, and every surgery is at least slightly different from others. Having a player take longer to return than another should not be considered a failure. In some cases, two players who are ready to perform at the same level the same number of days after their surgery will still return to game action at substantially different times, merely because of the timing of the major league schedule relative to their readiness date.

The following table shows the average times for players to achieve certain recovery milestones after the date of their Tommy John surgeries. I have included the standard deviation and the sample size, for completeness.

TJ Surgery Rehabilitation Milestones
Milestone Average Std. Dev. Sample
Throwing 153 24 33
Mound 303 36 16
Bullpen 326 48 21
Live Hitters 394 142 27
Game 431 108 111
Game, Same Level 568 303 597
Milestone numbers in days

All data collected for the table above were from Tommy John surgeries to professional players performed since 2007. There is a clear progression from beginning to throw again, to throwing off a mound, to a more formal bullpen session, to facing live hitters, to entering a game for the first time (often at a lower level as part of a rehab stint), to finally returning to pitch at the same level of baseball the player was playing in at the time of the surgery. It is not surprising that the standard deviation grows the farther along in the rehabilitation process the milestone represents, as there is more opportunity for a player to experience a setback or stall at a particular stage.

The following table illustrates the typical return times depending on the level of the player at the time of the injury.

TJ Surgery Return Times by Level
League Average Sample
Division I (College) 16.2 65
Rookie 15.9 60
Low-A 15.6 15
A 16.6 57
High-A 18.8 28
AA 17.2 61
AAA 19.7 45
MLB 18.2 146
Return times in months

Again all data used for this table was for Tommy John surgeries performed to pitchers only in 2007 or later. Note that the average return times for the lower levels of baseball are shorter than for the more advanced leagues. For players who are injured while performing in High-A ball or above, there are more opportunities to come back to play with a rehab assignment at a less advanced league before working back up to their previous level.

I also track, where possible, the surgeon for each procedure. This is generally available for surgeries to major league players, but reported far less regularly for minor league players. The following table shows the number of Tommy John surgeries performed by surgeons to major league players since 2013, which was the first year after the late Dr. Lewis Yocum last performed surgeries.

MLB TJ Surgeries, by Surgeon, By Year
Surgeon 2013 2014 2015 2016 2017
Dr. James Andrews 13 16 10 7 4
Dr. Neal ElAttrache 1 7 2 5 4
Dr. David Altchek 3 2 4 1 2
Dr. Keith Meister 0 2 3 0 4
Dr. Timothy Kremchek 1 0 2 2 3
Dr. Thomas Mehlhoff 1 2 0 1 0
Dr. George Paletta 1 0 1 0 1
Dr. Christopher Ahmad 0 0 2 1 0

The table includes only surgeons who have performed more than one Tommy John surgery on major league players during this time span. Certainly Dr. Andrews is still the most prolific Tommy John surgeon for elite baseball players, but the table indicates that players are seeking out a wider variety of surgeons over the past few seasons. The percentage of major league Tommy John surgeries performed by Dr. Andrews over this five-year period appears to have been 65 percent, 53 percent, 40 percent, 39 percent and 22 percent.

Since Tommy John himself returned to pitch in the majors in 1976, post-TJ pitchers have made at least 65,955 major league appearances for a total of at least 143,887 innings. That’s the equivalent of over three full seasons thrown only by pitchers who have recovered from the surgery.

Here are the all-time leaders in major league appearances and innings pitched after Tommy John surgery.

MLB Appearance Leaders After TJ Surgery (Pitchers)
*Active
MLB Innings Pitched Leaders After TJ Surgery (Pitchers)
Pitcher Post-TJ Innings Pitched
David Wells 3439.0
Tom Candiotti 2725.0
Tommy John 2544.2
A.J. Burnett 2206.2
Darren Oliver 1915.2
Anibal Sanchez 1592.2*
Jose Mesa 1517.1
Matt Morris 1475.1
C.J. Wilson 1430.1
Ryan Dempster 1423.0
*Active

Position players have appeared in at least 27,825 major league games after ulnar collateral ligament reconstruction surgeries, accumulating 100,933 plate appearances. Here are the leaders for most games played and most plate appearances after the surgery.

MLB Appearance Leaders After TJ Surgery (Position Players)
Player Post-TJ Appearances
Paul Molitor 1918
Matt Holliday 1878*
Rey Sanchez 1490
Kelly Johnson 1312
Jay Payton 1259
Shin-Soo Choo 1257*
Luke Scott 889
Greg Colbrunn 870
Matt Carpenter 864*
Jose Canseco 855
*Active

If Matt Holliday signs on for one more season, he could surpass Paul Molitor for the all-time lead in post-Tommy John surgery games played.

Major League Plate Appearance Leaders After TJ Surgery (Position Players)
Player Post-TJ Plate Appearances
Paul Molitor 8688
Matt Holliday 7916*
Shin-Soo Choo 5485*
Rey Sanchez 5246
Kelly Johnson 4805
Jay Payton 4490
Jose Canseco 3700
Matt Carpenter 3638*
Luke Scott 3193
Darryl Hamilton 3184
*Active

With so many pitchers having Tommy John surgery over the years, have you wondered how much “dead” salary teams have paid while players are unable to play while rehabilitating from the procedure?

I looked at major league player surgeries and pulled salary data from one of three sources (Lahman database, baseballchronology.com (now defunct), and spotrac.com). I noticed that these sources did not always agree on salaries for given players in given seasons, and without knowing which is the most reliable, assume all numbers should be considered good estimates, but estimates nonetheless. With this salary information, I calculated how much of each player’s salary corresponded to time away from the majors due to Tommy John surgery.

To do this, I pro-rated the partial year lost based on the total number of months of a given season a player was post-surgery in the year of the Tommy John surgery, as well as the number of months in rehab prior to returning in the return season. For these purposes I considered only April-October. I included all full seasons lost in between the year of surgery and year of return.

By doing this, I was able to get “dead” salary estimates for all but about 50 major league players who had Tommy John surgery. These remaining players either had the surgery pre-1985, when salary information is hard to track down, or were primarily on a minor league salary in the year they played a little in the majors and tore their UCLs.

Of course teams may have insurance for some or all salaries. There may be additional costs or savings associated with having an injured player aside from a player salary number. A large number of minor league players have had this surgery, and despite their depressed salaries, organizations would incur a cost for those injuries as well. They are not included in this calculation.

As of the end of the 2017 season I calculated an estimate of over $850 million in salary for major league players paid while they were unable to play due to Tommy John surgery and the subsequent recovery period.

Roughly seven out of every eight MLB games you watched last year involved a pitcher whose career has been extended due to this surgery. More than a quarter of current major league pitchers have had it. While players have been recovering from having to undergo the procedure, my estimate is that it is approaching a billion dollars in sunk salary cost for organizations. For the past six years, I’ve recorded more than 100 Tommy John surgeries performed each year on professional players, and we know the numbers are far higher among amateur pitchers in college and high school. There is a reason the term “epidemic” gets used regularly when referring to Tommy John surgeries.


Jon Roegele is a baseball analyst and writer for The Hardball Times. He was nominated for a SABR Analytics Conference Research Award in 2014 and 2015. Follow him on Twitter @MLBPlayerAnalys.
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Jacob Faria
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Jacob Faria

I’m next in line

Moranall
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Moranall

Am I blind or is the top table, “Percentage of 2017 MLB Games Featuring at Least One Pitcher Who Has Had TJ Surgery”, missing Arizona?

Lanidrac
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Lanidrac

On the table of most recent surgeries by team, you left out the Cardinals and Trevor Rosenthal, very ironic considering you opened with a picture of Rosenthal.

jfree
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jfree

Kind of surprising that Tommy John is still near the top of post-TJ innings – and not really very close since that top group laps ‘the field’

thepainguy
Member

Perhaps it’s time to talk about the Tommy John Twist?

Which is taught, not done naturally?

http://clients.chrisoleary.com/Pitching/The-Epidemic/The-Big-Five/Tommy-John-Surgery-Twist

jayman4
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Member
jayman4
Curious about of TJ surgeries, especially on the mix of outcomes. Come back, better. Come back, about the same, Come back, worse, don’t pitch/play again. I can envision cool ways of cutting it (age when surgery occurred; innings pitched before, by surgeon, etc). This would help answer the question, when you see, yet again, a promising player you cared about go do for TJ, what are the reasonable set of expectations for that player? This article asks, “how long will you probably wait” but seems to be focused on the universe of those that played again. Also, been curious if… Read more »
Barney Coolio
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Barney Coolio

I wonder if Japan, South Korea, Mexico, etc. have their own Tommy John surgery industries, or do players who need TJS come to the US? Or, is it just tough luck for TJS needing pitchers in foreign nations?

bwilden
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bwilden
Jon, thank you very much for this informative article. As a father who’s 19-year-old son is currently rehabbing from TJ, I have the gray hair as evidence of my anxiety of his rehab and hope he’s able to return to previous level of play. He’s currently redshirting as a freshman at a D1 mid level school after missing his senior HS season rehabbing a mild strain of UCL, which then tore on his first inning back on the mound. Do you have articles detailing how likely pitchers return to form? I’ve read different articles which describe rate of return anywhere… Read more »
Rays 7th Infielder
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Rays 7th Infielder

I believe Brent Honeywell and Jose De Leon would have been more recent TJ surgery recipients (?) for the Tampa Bay Rays and not Shawn Tolleson back in 2017.

drsteveh
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drsteveh

Great article! Thank you! Do you have any suggestions for injury prevention (risk mitigation)?

watsonjohn759
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watsonjohn759

It is great number that 1 out of 183 pitchers thrown at league level and did have Tommy John surgery. I think one must use to get acquainted with the situation. assignments writing