Throwing Heat: The Rise of Tommy John Surgery in Baseball

In the world of baseball, where velocity reigns supreme, a growing number of young pitchers are facing a career-altering challenge: torn ulnar collateral ligaments (UCLs). This injury, once considered a death sentence for a pitcher's career, has found a lifeline in the form of a revolutionary surgical procedure known as "Tommy John surgery." As the demand for this operation skyrockets, the sport is grappling with the implications of this medical intervention and the broader implications for the future of the game.

Unlocking the Potential of Pitching Prodigies

At just 13 years old, Quincy Bright was already on the fast track to the major leagues, boasting a fastball clocked at 95 mph. His talent and potential were undeniable, and he was quickly recruited by Mississippi State University. However, Bright's dreams were shattered at the age of 17 when he learned he had a torn UCL in his elbow. "I broke down in tears; I cried like a baby," he recalled. "I love the game so much, so me not being able to play, it just really hurt me. I just felt like I was letting people down."Bright's story is not unique. Thousands of young athletes have faced similar setbacks, only to find a glimmer of hope in the form of Tommy John surgery. This revolutionary procedure, named after the former Los Angeles Dodgers pitcher who underwent the first successful operation in 1974, has become a game-changer in the world of baseball.

The Tommy John Revolution

In the 1970s, a torn UCL was considered a career-ending injury. That is, until Frank Jobe, the Dodgers' team physician, developed a groundbreaking surgical technique to repair the damaged ligament. The procedure involves replacing the torn ligament with a tendon from the patient's forearm, effectively creating a "new" UCL."What Tommy John surgery involves is taking tissue from your forearm, a tendon, and replacing a ligament in your elbow, tighten it up, secure it, and that recreates a brand-new ligament that replaces the injured ligament," explained Dr. Chris Ahmad, Quincy Bright's surgeon and the chief of sports medicine at New York Presbyterian/Columbia, as well as the head team physician for the New York Yankees.The success of this procedure has been nothing short of remarkable. Today, an astonishing 35% of active Major League Baseball (MLB) pitchers have undergone Tommy John surgery, up from 27% in 2016. This surge in demand has led to a concerning trend, with the majority of these operations being performed on athletes under the age of 19.

The Pitching Velocity Epidemic

The rise in Tommy John surgeries can be attributed to several factors, chief among them the ever-increasing velocity of pitches in the sport. "The harder you throw, the higher your velocity, the more force on your ligament. And every year fastball velocity increases," said Dr. Ahmad.Indeed, the average major league fastball has increased by 2 mph over the past 15 years, now clocking in at 93.8 mph. This trend is not limited to the professional ranks, as it is also being observed at the amateur level. "In addition, the volume of throwing's going way up, meaning it used to be that you would play baseball during baseball season. Now you play year-round. It's a time bomb and an explosion about to happen in the elbow," Dr. Ahmad warned.

Addressing the Epidemic

Baseball Hall of Famer, MLB commentator, and Tommy John surgery recipient John Smoltz has been a vocal advocate for addressing the growing epidemic of pitcher injuries. Smoltz calls the rise in these injuries an "epidemic" and believes that a cultural shift is necessary to address the problem."Don't buy into thinking that this is normal for your 12-year-old, yet alone a 25-year-old," Smoltz cautioned. "We just act like, 'No big deal, have a Tommy John.'" Smoltz understands the pressure young athletes face, as they are often driven by the promise of financial rewards. However, he believes that the industry must "self-correct" through rule changes and philosophical changes.Smoltz's proposed solutions include Little Leagues discouraging uncontrolled pitching velocity and encouraging kids to take seasonal breaks from baseball. "When I see a young man just throwing everything he has at 13, he's not giving himself the best chance to pitch in high school," Smoltz said.

The Future of Pitching

Despite the challenges posed by the rise in Tommy John surgeries, the procedure has also provided a lifeline for young athletes like Quincy Bright. For better or worse, the legacy of 50 years of Tommy John surgeries means that players have a chance to strong-arm their way toward major league dreams.When asked what would happen if he did not play in the majors, Bright laughed and declared, "That's not gonna happen! I will be in the major leagues." This unwavering determination, coupled with the medical advancements that have made Tommy John surgery a viable option, suggests that the future of pitching in baseball may be forever altered.As the sport grapples with the implications of this surgical intervention, the question remains: can the industry self-correct and find a way to protect the long-term health of its young pitching talents, or will the lure of velocity and the promise of a second chance continue to drive the demand for Tommy John surgery?