Youthful fling with surgery

Times Staff Writer

There’s good news and bad news about “Tommy John surgery,” a technique used to replace a damaged elbow ligament often suffered by athletes, mostly baseball players. The surgery has a high success rate -- 83% -- with most people going back to previous levels of activity, a new study has found. However, more and more young athletes are having the surgery, leaving some experts concerned about the possible ill effects of overtraining.

“This is not a case of inadequate care,” says Dr. E. Lyle Cain Jr., fellowship director at the American Sports Medicine Institute in Birmingham, Ala. Cain was lead author of the study released two weeks ago at the annual meeting of the American Orthopaedic Society for Sports Medicine in Orlando, Fla. “I think many young athletes assume that the more they train and participate, the better they’ll become. The reality is that the body has to have a certain amount of time off.”

Tommy John surgery, or ulnar collateral ligament reconstruction, refers to the replacement of a damaged elbow ligament with a tendon from elsewhere in the body -- usually the forearm, according to Cain. The ligament, he says, provides stability when doing any throwing motion, but can fray, stretch or tear from overuse or without warning from one sudden movement. People with the injury usually experience a sharp pain while throwing, and for baseball players the injury can result in slower pitches and less control of the ball.

During surgery, the replacement ligament is woven through holes drilled in the humerus, a bone that runs from the elbow to the shoulder, and the ulna, a bone in the forearm. Cain says that healing usually takes about three to four months, but that complete recovery takes longer. The procedure was named for former Dodgers pitcher Tommy John, the first pro athlete to have successful surgery. It was performed in 1974 by Dr. Frank Jobe, who pioneered the procedure.


A slew of ballplayers have had the surgery, including Jose Canseco, Mariano Rivera, Josh Johnson and Jon Lieber.

The study tracked 743 people who had the surgery from 1988 to 2006 as patients of Dr. James R. Andrews, senior author of the study and founder of the institute. Their progress was followed for a minimum of two years. The majority (94.5%) were baseball players (high school to major league); the rest were involved in a variety of sports, including track and football. Some 83% were able to return to their previous level of competition or higher.

But Cain says that beginning in 2000, he and other physicians noticed a trend toward younger athletes needing the surgery. They backtracked surgical cases, discovering that from 1991 to 1996 about 12% of patients were 18 and younger, but by 2005, that number had risen to 30%. “If you look back 10 or 15 years ago, most [young] baseball players were multi-sport athletes,” Cain says.

“Over the last 10 years, people have become very specialized in sports. The body never has the recovery period it needs.” Many youth sports now are year-round, leaving little time off.


Cain advises that younger athletes not spend too much time in one sport, and cross-train to use different joints and muscle groups. If they do home in on one sport, Cain says it’s important to take a three- to four-month break.

“With our success rate of surgery,” he says, “some athletes and parents are numb to the idea of having surgery. Some athletes will even tell you it’s almost a badge of courage that they had reconstructive surgery done, that it’s a sign of being a good baseball player. Successful surgery,” he adds, “is important, but it’s also important to prevent these injuries at high school age or younger.”