May 3, 2007 / 9:54 PM / 13 years ago

Pitchers good as new after "Tommy John surgery"

NEW YORK (Reuters Health) - Major League Baseball pitchers who undergo “Tommy John surgery” to repair a ruptured ligament in the elbow will usually recover completely from the operation, pitching just as well as they did before the injury, a new study shows.

Of 68 Major League Baseball pitchers who underwent the surgery between 1998 and 2003, most (82 percent) returned to play within an average of 18.5 months post-surgery with no change in average earned run average or walks or hits per innings pitched, Dr. Brett W. Gibson of the Penn Sports Medicine Center in Philadelphia and colleagues found.

“The procedure kind of anecdotally among the major league players has a pretty good reputation,” Gibson noted in an interview with Reuters Health. But no study has systematically looked at the outcome of the surgery, known medically as ulnar collateral ligament reconstruction, in major league players, he added. One in nine active major league pitchers, or about 600 in any given year, have had the procedure, he pointed out.

To investigate the surgery outcomes, Gibson and his team compared 68 pitchers who had thrown in at least one major league game before requiring the surgery to a group of 112 randomly selected pitchers who never had this surgery (the “controls”).

For the reconstructed players, performance was compared before and after the surgery, while control pitchers’ performance was compared before and after 2001.

Fifty-six of the players were back on the mound by 18.5 months after surgery, the researchers found, with no change in their performance.

Starting pitchers were 2.6 times more likely to require elbow reconstruction, consistent with the hypothesis that the injury is typically due to overuse — starters throw many more pitches per inning than relievers. The researchers also found that pitchers with better ERAs were at increased risk of having the surgery, as were those who had spent less time playing in the major leagues.

Gibson and his colleagues suggest that better performance — including faster pitches and more breaking pitches — may demand a style that boosts the risk of injury. The fact that more experienced players faced less risk of injury may be because they “demonstrate superior pitching mechanics that are protective with regard to injury,” allowing them to have longer careers, the researchers add.

It’s also possible, they note, that older pitchers faced with a surgery that requires two years of recovery time may decide to retire instead.

SOURCE: American Journal of Sports Medicine, April 2007.

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