By Dev K. Mishra, M.D.
President, Sideline Sports Doc
Clinical Assistant Professor of Orthopedic Surgery, Stanford University
- Elbow ulnar collateral ligament reconstruction is a highly successful operation, from which many throwers come back and compete
- Throwers often feel they return to play with better velocity and command than they ever had
- The results are likely due to a combination of one year rehab to optimize leg, core, and shoulder strength combined with a technically skillful operation
We now have a solid understanding of the behaviors that place a thrower at risk for elbow injuries, but making inroads in changing that behavior remains a challenge. For example, 40% of youth pitchers report throwing in chronic elbow pain, and 25% of Major League Baseball pitchershad “Tommy John” surgery at some point in their career.
That last statistic for the MLB players leads some young pitchers to an interesting conclusion: “I should just go as hard as I can, and if I tear my ulnar collateral ligament in my elbow I’ll have surgery and come back better than before. MLB pitchers do this often.”
The reality is that surgery to reconstruct a torn ulnar collateral ligament (UCL) does not make the elbow stronger and better than it was before the injury. Many pitchers do successfully compete again after surgery but it’s likely due to extensive rehabilitation to correct underlying functional issues as much as it is to skillful surgery.
As more and more players injure the UCL, many of them elect to have surgery. The surgical techniques have evolved and improved, and understanding of proper rehabilitative techniques has also advanced. The result is that there are plenty of pitchers and throwers who do very well and claim that they come back from surgery with substantially better velocity and command than they had before surgery.
When throwers successfully come back and feel great, it’s tempting to think that Tommy John surgery is some type of performance enhancing procedure. Odds of success are generally very good; 70% of teenage throwers come back to the same or higher level, and about 83% of professional players come back to the same or higher level. It’s a very good outcome but not perfect.
Surgical technique has evolved quite a bit over the last few decades but no surgeon would claim that we could create a better ligament after surgery than the one you were born with. It’s far better to keep your original parts healthy than to have surgery.
The other hard truth is that after surgery the athlete will typically be off throwing for around a year. During that time there will be extensive emphasis on optimizing strength and function of the lower extremities, core, and shoulder. There will be a gradual and strict throwing protocol focusing on form and function.
For almost all throwers undergoing surgery, this year spent after surgery will be the first time they’ve ever devoted to total body reconditioning in their lives.