Tommy John surgery: The next student steroid?

By Loren Grush

When it comes to high school and college sports, young athletes often yearn for bigger muscles to enhance their performance. But for student baseball pitchers, strength isn’t so much the goal as it is speed – throwing speed, that is.

Now, student athletes looking for a way to get an extra boost in their pitching arm have been putting their hopes in an elective surgery called ulnar collateral ligament (UCL) reconstruction – more famously known as Tommy John surgery.

However, according to one doctor, misconceptions surround Tommy John surgery, cautioning it isn’t necessarily the miraculous savior that student athletes think it is.

“They believe the surgery can allow you to throw more effectively,” Dr. Christopher Ahmad, an associate professor of orthopedic surgery at Columbia University and head team physician for the New York Yankees, told FoxNews.com. “It’s not much different than thinking performance enhancing drugs can make you throw harder.”

Surgery risks, recovery

Named after former Los Angeles Dodgers pitcher Tommy John, the reconstructive elbow surgery became famous in 1974 when John damaged his UCL in the middle of a great 13 - 3 season. With no options available and desperate to keep playing baseball, John approached Dr. Frank Jobe – an orthopedic surgeon and special advisor to the Dodgers – begging him to come up with a surgery to save his pitching arm.

Jobe eventually figured out a way to replace John’s injured UCL with a tendon graft from his forearm. Once John underwent the surgery and fully recovered, he returned to baseball in 1976, ultimately winning more games after his surgery than before.

According to Ahmad, because of John and others like him who have had successful careers post-UCL reconstruction, student athletes are starting to get the wrong idea about Tommy John surgery. In a recent study published by Ahmad in The Physician and Sportsmedicine, 50 percent of student athletes believed the surgery should be performed in absence of injury in order to improve performance – a mindset, he said, that could prove to be dangerous.

“I may see 20 kids a week with elbow pain; sometimes they have real pain, or they say, ‘I’m sore and my performance is down,’” Ahmad said. “Then they’ll say something like, ‘Can you do an MRI scan for me? I may need Tommy John surgery.’ It’s dissatisfaction with performance and a rationale that Tommy John surgery will make them better.”

Ahmad said it’s important for students to focus on the third word: surgery. With every operation, no matter where in the body, there are always risks. For those who wind up having UCL reconstructive surgery, they run the risk of their elbow becoming permanently stiff, their muscles tearing or having iatrogenic (physician-induced) problems in their elbow.

Also, those who have UCL reconstruction won’t be playing ball anytime soon after the procedure.

“It takes a full year to recover,” Ahmad said. “It’s an obligation and responsibility you have to do rehabilitation for a full year. They don’t understand what the time frame is to get back. They think next week they’ll be throwing 90 miles per hour… In reality, the success rate of having Tommy John surgery is between 70 and 80 percent to full level of throwing.”

As for why this misconception exists, Ahmad believes those who receive Tommy John surgery may play better afterward simply because their injury is no longer ailing them. Also, the ‘success rate’ of Tommy John surgery may be a bit skewed.

“The people who come back and play better – they’re the ones who get highlighted,” Ahmad said. “The public doesn’t hear about the athlete who did not come back. He falls off the media’s radar, so all the failures that are out there, [students] don’t hear about it. There’s no research that says if you have surgery, you come back and throw faster and harder.”

Disturbing trends

In lieu of this false belief, Ahmad said he’s seen a disturbing trend in which students believe if they blow out their elbow ligaments, they can qualify for Tommy John surgery and become better players. Pitchers and coaches alike have become more reckless during practice and play, Ahmad said, because they wrongly believe that injuries can easily be fixed with surgery. According to his research, 30 percent of coaches did not believe that throwing too much would lead to injury.

Because of these alarming patterns, Ahmad said it’s important for sports physicians to reach out to both students and coaches about the dangers of overthrowing. It’s recommended that students take two to three months off a year in order for their tissue to recover and avoid rupture. It’s important to remember that an athlete’s muscles and tissues are constantly growing – and need to be cared for.

“If you are a developing athlete at 16, you’re going to get better and be a better athlete at 19,” Ahmad said. “If you have Tommy John surgery during that development, you’re going to develop as a pitcher, but the surgery itself doesn’t allow you to throw at higher velocities.”