OAKLAND — Tommy John, frustrated by relentless elbow pain and repeated cortisone injections, reached out to the Los Angeles Dodgers’ team physician, seeking any possible option to salvage his baseball career.

Dr. Frank Jobe, who previously assisted polio patients through tendon transplants, shared with John that he could make a trial attempt to address his elbow condition. The odds were only 1 in 100 for a successful outcome that would allow him to pitch again.

Without hesitation, John gave his consent for any procedure necessary. Jobe conducted the surgery, harvesting a tendon from John’s left wrist, drilling four holes into the bones of his right elbow, and securing the tendons with anchors.

This groundbreaking event took place on September 25, 1974.

Half a century later, this surgery stands as one of the most significant and pioneering operations in sports medicine.

Commonly known now as “Tommy John surgery,” it has profoundly influenced the careers of many athletes.

“It’s astonishing how many players have been able to continue because of this surgery,” John, now 81, shared in an interview with YSL News Sports from his home in Florida. “At the time, it was just an experimental procedure. I was eager to explore anything that could help me pitch again. I told Dr. Jobe to do whatever was necessary. If it works, then great! If not, then at least we tried.”

“Thank goodness it was successful. It’s a true blessing. What saddens me is that 50 years later, the need for this surgery has grown more than ever. You’d expect that with advances in training and techniques, pitchers would rely on it far less.”

After being the first athlete to receive surgery to replace his ulnar collateral ligament, John continued his career for another 14 years, achieving 164 more wins. It took four years before another surgery was performed on San Diego Padres pitcher Brent Strom, who, as the pitching coach for the Arizona Diamondbacks, never returned to the major leagues.

Currently, studies indicate that 36% of all active Major League pitchers have undergone Tommy John surgery, and this trend is on the rise each year. The number of surgeries performed last year surpassed all those in the 1990s combined.

“This wonderful surgical procedure has, unfortunately, resulted in a problem,” Dr. James Andrews, who retired in January, stated to YSL News Sports. “Success often brings its own set of challenges, and we now need to address these issues.”

“Originally meant for professional players, the frequency of ligament injuries in youth sports has now surged tenfold since 2000. Many young players are injuring their arm ligaments before even finishing high school, leading them to seek surgery too early. This is alarming. I can hardly express how concerning this is,” he noted.

Andrews pointed out a troubling trend: parents are enthusiastically bringing their children in for elbow surgeries, mistakenly believing that it will strengthen their ligaments and boost their chances of becoming major league players.

“I see parents smiling as they bring their kids in to hear they need surgery,” Andrews said. “Some of these kids don’t even require the operation, but they ask for it anyway. Some are as young as 12 and haven’t fully matured yet.”

“That’s just not right. It’s absurd. While this procedure can be miraculous for many, it has only an 85-to-90% success rate. I try to explain this, but many parents are indifferent. It’s truly disappointing.”

Experts such as Dr. Neal ElAttrache, Dr. Keith Meister, Dr. Tim Kremchek, and Andrews argue that the primary issue stems from baseball’s obsession with throwing speed. Young athletes are aiming to throw every pitch with maximum effort to catch the attention of professional scouts and colleges. Meanwhile, professional players push for peak performance to secure larger contracts.

When injuries occur, players often resort to surgery and can sit out a year to recover. If they need another surgery down the line, they seem unconcerned.

“These players come in giving it everything they’ve got,” Kremchek, the Cincinnati Reds’ medical director and chief orthopedic surgeon for 26 years who has performed over 3,000 surgeries, commented. “The human body has its limits. A consistent cycle of operations leads to an inevitable loss of options for repairs.”

“The modern fascination with throwing velocity has fundamentally altered the game. The focus has shifted from mastering pitching to just generating speed. It’s detrimental to the sport.”

Meister noted that only three pitchers threw over 94 mph at a Perfect Game showcase in 2012, but that number jumped to 17 the following year.

In 2023, that number reached 54 pitchers who could throw 95 mph or more.

“The extreme emphasis on pitch speed and spin rate has transformed the landscape, creating immense challenges for the future. With so many pitchers throwing at such high velocities, the longevity of ligament health is compromised. It’s simply not a sustainable approach,” Meister explained.

“The conversation needs to shift back to realistic practices. Currently, things are moving in the wrong direction, and it’s frustrating. I’ve proposed several potential solutions, but they have yet to gain traction.”

As part of a committee addressing this issue, Meister has suggested that even though the sport can’t limit how fast pitchers throw,

What about implementing rule changes to alleviate some stress? One suggestion was to make a rule where a player who fouls off a pitch with two strikes is automatically out. However, this proposal was quickly rejected as MLB aims to boost offensive play rather than limit it. Another idea proposed was to alter the walk rule from four balls to three, which would significantly cut down the total number of pitches thrown throughout the season.

“Why can’t we take dramatic action?” asks Meister, who conducted 240 Tommy John surgeries last year and expects to perform 300 this year. “Other sports make adjustments and adapt. There’s the three-point line in basketball. You have the two-point conversion in football. Why not have baseball adapt in a similar way?”

“You won’t see changes at lower levels unless high-level changes are made. We need to address the problem.”

ElAttrache completely supports this notion, asserting that MLB needs to implement rule changes to safeguard pitchers and allow them to pitch longer into games. When John made his comeback in 1977, winning 20 games and finishing second in the Cy Young race, there were a total of 907 complete games that season, including 11 by John himself.

This season, however, there have only been 27 complete games total, with no pitcher attaining more than two.

“I’ve discussed with the commissioner’s office the need to reduce pitchers’ exposure,” ElAttrache explains. “If we consider the number of stressful innings and pitches these players are throwing, maybe we should implement a rule where hitters face a maximum of seven or eight pitches. After that, if they haven’t walked, struck out, or gotten a hit, they’re automatically out.”

Max Scherzer, a three-time Cy Young award winner for the Texas Rangers, argues that MLB should lift the complete ban on using certain sticky substances. He contends that the ban has led to an increase in UCL surgeries because it forces pitchers to grip the ball more tightly to boost their spin rate and speed.

The surgeons are in agreement.

“With the removal of tacky substances, pitchers are now gripping the ball excessively on every throw to achieve the required spin,” ElAttrache notes. “They’re making their grip incredibly hard on the flexor pronator tendons in the elbow.”

“Additionally, with the introduction of a pitch clock, we’ve eliminated the opportunity for recovery between pitches. When a pitcher is fatigued, research indicates that fatigue is the leading factor linked to injuries.”

Meister states: “They’re compelling pitchers to grip the baseball even tighter, which places extra stress on the elbow. I don’t understand why they can’t allow the use of pine tar; it’s used by hitters. Why not permit it on the mound? I’m not advocating for excessive use, but there must be a reasonable compromise if they genuinely want to help prevent these injuries.”

The doctors warn that MLB needs to find effective solutions quickly, or they might soon deplete their roster of pitchers.

“I’d like to see radar guns banned at the high school level,” Kremchek suggests, “to encourage pitchers to master pitching techniques instead of merely focusing on speed. Looking back, that’s why Tommy John’s surgery was a success. He was only throwing in the mid-80s. If he had been throwing over 95 mph, he likely would have injured himself worse, and Tommy John surgery might never have become well-known.”

John, who is set to have surgery in October for bladder cancer, also reflects on what might have transpired if his surgery hadn’t been successful. There were complications, and unlike today’s pitchers, he didn’t instantly bounce back. Before his surgery, he had a record of 13-3 with a 2.59 ERA, but it took him 2.5 years to regain his dominant performance.

“Had the first procedure been unsuccessful, I know Dr. Jobe would have attempted it again,” ElAttrache states. “Frank was convinced that he had identified the lead cause of these elbow issues in pitchers and believed his method was a solid treatment option. His experience with polio patients and tendon transfers informed his belief that such methods could effectively reconstruct the ligament.”

Dr. Jobe, who passed away in 2014 and was considered one of the finest surgeons, expressed such confidence in his abilities that when he was honored by the Baseball Hall of Fame in 2013, he offered an apology to Sandy Koufax at dinner. Koufax, who posted a remarkable 27 wins with a 1.73 ERA in 1966, retired abruptly after 12 seasons due to persistent elbow pain, at the age of just 30.

“Frank apologized to Sandy in front of all of us for not having thought of this surgery earlier,” ElAttrache recalls. “He believed it could have saved Sandy’s career.”

But it was just in time to save John’s career. After achieving 288 victories, there’s one question John is often asked regarding the surgery.

Why is it named after him and not Dr. Jobe?

“I once asked Frank about that,” John recounts. “He was such a modest person, but he replied that he was tired of saying ‘ulnar collateral ligament replacement surgery using the palmaris longus tendon.’ It was simpler for him to say, ‘Oh, the surgery I performed on Tommy John.’

“And so, it became known as ‘Tommy John surgery.’”

Now, 50 years later, this procedure has become a staple in the game, with pitchers undergoing it multiple times due to advancements like the internal brace method, which can shorten recovery to about one year, rather than 14 to 18 months.

“The internal brace has made significant progress,” Andrews shares from his home in Birmingham, Alabama, “and soon, all will likely benefit from this procedure. However, many of these are re-do surgeries. A pitcher might recover, throw 100 mph again, and then wind up needing a second surgery. They often don’t understand that re-do surgeries have only a 40% success rate.”

Andrews pauses and adds, “We’ve dedicated too much time fixing injuries without focusing enough on prevention. Instead of counting the number of surgeries performed, let’s aim to reduce the number we need to conduct.”

“We are responsible for this situation.”

“It’s time to find a solution.”

Follow Nightengale on X: @Bnightengale