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Sims: Why Are So Many Pitchers Having To Undergo Tommy John Surgery?

By Abby Sims
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Many have taken note of the epidemic of Tommy John surgeries in baseball of late, and the reason for it is both straightforward and enigmatic. Straightforward because an elbow wasn't designed to pitch, especially repetitively and with such velocity. Many are destined to break down. A bit of a mystery still because it seems like more athletes face this surgery than in the past. Why is that?

It would be interesting to look at a detailed analysis of pitchers then and now -- their careers and performance. Is the average career longer? Is the average pitch of each type faster? Does the typical pitcher now employ a wider variety of pitches, with those other than fastballs placing him at an increased risk? Did the pro athletes of days past play a variety of sports as kids rather than focusing on baseball from an early age, as many now do? Is the average career longer, surgery notwithstanding (rendering age a factor)?

If the answer is yes to any number of these questions, there might be an explanation in there somewhere.

Dr. James Andrews, a leading orthopedic surgeon who is one of the go-to docs in the sports world, reportedly attributes the prevalence of the procedure at least in part to the year-round pitching at youth levels and a lack of needed rest that should include several months off.

Add into the equation that the procedure has become so commonplace and is used more readily, while injured pitchers in the pre-Tommy John era might have quietly faded from view. Sandy Koufax is the perfect example of a star who might have bought a few more good years.

Even with offseason programs and pitch-count limits, overuse abounds and elbow ligaments fail. (Overuse is simply demand on tissue that exceeds its ability to withstand damage.) The benefits of an attentive focus on pitching mechanics and the use of advanced technology to identify flaws and enhance performance remains to be seen.

If clubs are making the best use of these tools, either they haven't had the desired impact or pitchers have a difficult time modifying their mechanics. Or, with all ligaments not created equal -- and some working in combination with less than ideal alignment, strength, flexibility or range of motion -- even good mechanics can take a toll.

To learn about the elbow anatomy and the Tommy John procedure, take a look at a previous article from this blog. You might also be interested in outcome studies, which demonstrated the effectiveness of the surgery in restoring full function and return to play. One, done by the Kerlan-Jobe Clinic, showed that 83 percent returned to their previous level of play. Another, which analyzed a much smaller group of patients that had undergone the modified "docking" procedure, demonstrated a 92 percent success rate.

As of July 2013, there were 124 MLB players on a list of active pitchers who'd had Tommy John surgery. That represented roughly a third of the 360 who started the 2013 season -- an alarming statistic. Because the list is incomplete for 2013 and does not include those who have had or face the surgery this season, I've added the information below. Even though we are only in spring training, the list is expanding quickly.

Additional players who had surgery in late 2013 include:

-Matt Harvey, Mets: October 2013 (first time out)

Also set to undergo his second Tommy John surgery is Cory Luebke (Padres), whose first surgery was performed in May of 2012. His ulnar collateral ligament re-tore before even making a complete comeback, and it remains to be seen whether he will be able to return to the mound in 2015.

Another "active pitcher" who faced a Tommy John revision in 2013 -- while still rehabbing from the 2012 surgery – was Daniel Hudson of the Diamondbacks.  Hudson's second surgery took place in June, 11 months after the first.

A few pitchers on the 2014 Tommy John roster are also going in for revision procedures. These include:

-Jarrod Parker, A's (whose first procedure was performed in 2009)

-Kris Medlen, Braves (whose previous procedure was performed in 2010)

-Brandon Beachy, Braves (likely slated for surgery though currently getting a second opinion after already seeing Dr. Andrews)

Patrick Corbin of the Diamondbacks is also slated for the procedure, his first.

Other active pitchers who doubled down on Tommy John surgeries in the past include Brian Wilson (Dodgers), Joakim Soria (Rangers), Chris Capuano (Red Sox), Jason Frasor (Rangers) and Kyle Drabek (Blue Jays).

There is generally more difficulty with revision procedures because the desired tendon graft was already harvested, and the bone -- though healed -- had been drilled previously to weave the tendon graft through, leaving a less pristine joint.

Still other pitchers are attempting to work their way back:

Ryan Madson is currently a free agent. He had Tommy John surgery in 2011 but suffered complications in his recovery.

Journeyman Arodys Vizcaino of the Cubs also has yet to rebound from March 2012 Tommy John surgery, but is supposedly on track to return to the bullpen this season after a recovery that was delayed due to complications from a buildup of calcium deposits in his elbow.

Sean Burnett (Angels) is recovering from August surgery to repair a torn flexor tendon in his elbow, this after having had Tommy John in 2004. He is pitching bullpen sessions in an attempt to return this season. The fact that he tore the flexor tendon, which is situated alongside the ulnar collateral ligament, does not bode well for him long-term because he clearly continues to stress the medial compartment of his elbow to a degree that he cannot structurally withstand.

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