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Young Pro Pitchers & Risk of 'Tommy John' Surgery

Most players who needed the ligament procedure had it within first 5 years of professional ball

WebMD News from HealthDay

By Robert Preidt

HealthDay Reporter

THURSDAY, July 10, 2014 (HealthDay News) -- Pitchers who start playing Major League Baseball at a young age may be at increased risk for requiring elbow surgery later in their career, according to a new study.

Researchers looked at 168 pitchers who spent at least one season in the major leagues and subsequently had surgery to repair a torn ulnar collateral ligament (UCL) in the elbow of their throwing arm.

These players were compared to 178 age-matched major league pitchers who did not undergo UCL reconstruction, widely referred to as "Tommy John" surgery.

About 60 percent of the pitchers who required UCL reconstruction had the surgery within their first five years of being in the major leagues. Compared to pitchers who did not have the surgery, those who underwent the procedure had more major league experience at the same age, which suggests that arm stress from earlier major league experience contributed to the elbow damage, the study authors said.

The researchers also found that pitchers who entered the major leagues at younger ages appeared to be more likely to require UCL reconstruction. In addition, the study found that 87 percent of pitchers who had UCL reconstruction returned to major league play, but had a significant decline in performance after their return.

"Our results suggest that UCL reconstructive surgery does a tremendous job in allowing players to return to their same level of sport but it also describes a decline in pitching performance after undergoing reconstruction," study lead author Dr. Robert Keller, of Henry Ford Hospital in Detroit, said in a news release from the American Orthopaedic Society for Sports Medicine (AOSSM).

"We also found that there is a statistically significant decline in pitching performance the year before reconstructive surgery and this decline was found to be a risk factor for requiring surgery," Keller explained.

"Having athletic trainers and team physicians closely look at when players' pitching performance stats start to decrease may allow for steps to be taken with a pitcher before a surgery is needed," Keller suggested. "Our study also further highlights the need for kids not to overuse their arms early in their pitching careers," he added.

Study results were presented Thursday at the annual meeting of the AOSSM. Findings presented at meetings are generally considered preliminary until they've been published in a peer-reviewed journal.

The UCL is located on the inside of the elbow and connects the bone of the upper arm to a bone in the forearm. "Tommy John" surgery is named after former major league pitcher Tommy John, who was the first ballplayer to undergo the procedure back in 1974.

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