Tracing the History of Tommy John Surgery Since 1974 Through Key MLB Pitchers
Since 1974, thousands of pitchers have had the same elbow reconstruction surgery first performed on Tommy John by Dr. Frank Jobe. Today, nearly one-third of current MLB pitchers have undergone the surgery, proving that this surgery has not only changed the game, it may have saved it.
While the surgery is universally known by the name of its first patient, there are plenty more in the club who share that unique triangular scar on the back of their pitching elbow. The history of the last 40 years of baseball can be traced through some of the men who have undergone the procedure.
I've proceeded chronologically, starting with the 1970s and then going by the half-decade, showing the exemplars of each era as baseball itself has overcome an injury to become a post-surgical entity.
This slideshow is one of a package of stories about Tommy John surgery that Bleacher Report is presenting in advance of this month's Baseball Hall of Fame ceremonies, at which Jobe will be honored. The other pieces look at the surgery's history and impact, detail the procedure and the questions surrounding it, and discuss the startling increase in Tommy John patients.
1970s: Tommy John
Before: All-Star in 1968; 11 solid seasons with White Sox and Dodgers; ERA no higher than 3.91 in any season.
After: 1976 Comeback Player of the Year; three more All-Star Appearances; 164 wins post-surgery; pitched until he was 46 years old; 2,245 career strikeouts and 3.34 ERA.
Of note: Jobe created the surgery in 1974, allowing Tommy John to return to his career after rupturing the ulnar collateral ligament (UCL) in his pitching elbow. While it took John almost 18 months to return, he did return. He went on to have almost as many wins (164) after his surgery as he did before, playing 15 more years for the Dodgers and Yankees.
John still throws regularly and has had no issues with his reconstructed ligament in nearly 40 years. The closest he came to making the Hall of Fame was receiving 31.7 percent of the vote in 2009 (75 percent is required), but with his historic involvement with this surgery, he definitely should be in Cooperstown.
1970s: Brent Strom
Before: A 3.95 ERA overall in 501 innings; two solid seasons in 1975-76 with the Padres, where he went 20-24 with a 3.02 ERA.
After: Was not able to return to the majors.
Of note: While Tommy John has his name on a surgery, and Sandy Koufax has frequently joked that it should have been him, few can answer this trivia question: Who was the second pitcher to undergo Tommy John surgery?
The answer is Brent Strom.
A pitcher with the Mets, Indians and Padres, Strom was a USC student when he first came into contact with Jobe. He went on to be a pitching coach with several organizations and is the minor league pitching coordinator for the St. Louis Cardinals.
Early '80s: Tom Candiotti
Before: Relatively unknown minor league pitcher who had to convince Jobe to actually operated on him.
After: Pitched 16 years in the majors with 151 career wins and a 3.73 ERA; third-most wins post-surgery (Wells 239, John 164); knuckleballer who threw 68 complete games in career, including 17 in 1986; pitched until he was 41 years old.
Of note: There is a great gap in the knowledge of exactly who had Tommy John surgery in the early 1980s. Unfortunately, records and attempted reconstructions leave us with a dark age for the procedure.
The best-known pitcher to undergo Tommy John surgery during this period was Tom Candiotti. At the time, he was a minor leaguer in the Milwaukee system. After being diagnosed with an elbow sprain, Candiotti came to Los Angeles to meet with Jobe.
Jobe asked him whether he was a prospect and if he really wanted to have the surgery. He was and he did, coming back to become one of the more durable pitchers in the major leagues. He switched to the knuckleball after his surgery because he never regained all of his velocity.
Candiotti sends Jobe a present every year, signed, "Your Prospect."
Early '80s: David Wells
Before: Decent minor leaguer for two seasons.
After: Career 4.13 ERA; started 489 games; threw perfect game; three All-Star rosters; World Series championships with Blue Jays, Yankees.
Of note: David Wells made perhaps the biggest post-surgery leap of success for a Tommy John pitcher.
"Boomer" had the surgery while in the Blue Jays minor league system at 22. It slowed his ascent to the major leagues and kept him in the 'pen until he was 30. After that, he never looked back, putting up 239 wins and one of two perfect games by a Tommy John patient (the other was by Kenny Rogers).
The ligament in his elbow lasted 22 years, which appears to be a major league record. There's also the chance that Wells was the first patient to undergo the procedure at the hands of Dr. James Andrews. (When asked, Andrews could not recall who his first Tommy John patient was.)
Early '80s: Jim Morris
Before: Struggled making it out of Class-A baseball; moved around from team to team; retired then unretired.
After: Started throwing 98 mph and got a shot with the Rays at 35 years old; able to make it to the majors in 1999; had 16 career appearances with an ERA of 4.80 in 15 innings pitched; subject of a movie.
Of note: Jim Morris is more famous for the movie The Rookie than for his pitching.
Late '80s: Jimmy Key
Before: Solid pitcher with All-Star appearance in 1985 and 2.76 ERA in 1987.
After: Two World Series championships, with Yankees in ’96 and Blue Jays in ’92; three more All-Star appearances; 186-117 career record; 3.51 ERA.
Of note: The late 1980s offer few examples of Tommy John patients. Jimmy Key and Kenny Rogers (see next slide) are associated with having had the surgery, but given their short rehab times and the lack of medical records, it's hard to fully confirm what was done.
Key was a very good control pitcher, but he was also injury-prone. It's little surprise that he would end up having Tommy John surgery, but the surgery didn't keep him from missing time due to shoulder injuries down the line.
He did win the ERA title in 1987, just before presumably undergoing Tommy John surgery. It is unclear when Key had his surgery, but the game logs show us that he pitched in October of 1987, then in three games in April of 1988 before taking a break until June. He then pitched until September. That means Key may have come back from Tommy John surgery in as little as six months!
Adding to the mystery, a contemporary account says that Key had "only a bone chip." (Thanks to Phil Eager for digging that one out of the archives in response to a Twitter query!)
Late '80s: Kenny Rogers
Before: Minor leaguer slowly made way up to majors.
After: Four-time All-Star; 219 career wins with a 4.27 ERA; played in 81 games with Rangers in 1992 and had an 18-9 record in 2004 with 126 strikeouts in 211.2 IP.
Of note: Kenny Rogers made it back from Tommy John surgery and worked his way into the Rangers rotation. While losing a year to surgery may have slowed his progression, it also may have kept him from getting overworked at a younger age.
Rogers not only had his elbow reconstructed, he was also one of the first pitchers diagnosed with thoracic outlet syndrome, an injury in the shoulder and neck area that is seen more often these days. (Both Chris Carpenter and Josh Beckett are coming back from the issue currently.)
Rogers' injuries probably prevented him from challenging for 300 wins and a Hall of Fame bid, but without those surgeries, he wouldn't have had a career at all.
Early '90s: Darren Dreifort
Before: Made MLB debut without going through minors; injuries hampered start of career; solid season in 2000 (12-9, 4.16 ERA) earned him a $5 million contract.
After: Never made the jump after surgery; continued to be a mediocre player many now consider a bust; career ended with disappointing numbers of a 48-60 record, a 4.36 ERA and a lot of disappointment for Dodgers fans.
Of note: In the early '90s, the surgery was less of an oddity, but baseball was learning quickly that the procedure wasn't foolproof. While the surgery could return a player, it couldn't make him better.
Darren Dreifort was a top pick of the Dodgers, but his violent mechanics quickly led to arm trouble and eventually Tommy John surgery. Dreifort's mechanics remained an issue after he came back, and he never was able to recapture the early promise. And yes, $5 million was a really big number back then.
Early '90s: Jose Rijo
Surgery: Five times between 1995-2000.
Before: World Series champ and World Series MVP in 1990; All-Star in 1990.
After: Missed five full seasons and was never able to make a real comeback; pitched 94 innings in the final two seasons of his career in 2001 and 2002; record of 116-91 and ERA of 3.24 with 1,606 strikeouts for his career.
Of note: Five times. Jose Rijo is assumed to have the record for Tommy John surgeries, which isn't something anyone wants. (Scott Williamson and Chad Fox are just behind at four.)
Rijo had several revisions due to starting a throwing program too soon, re-injuring the new ligament. He was at the end of his career at the time of his surgeries and was determined to get back to baseball, even though his arm was clearly shot.
There was a great deal of debate as to whether there was a point where an arm could not be helped by Tommy John surgery or if there was a maximum age. Jamie Moyer's surgery at age 48 in 2011 showed that the maximum age might be higher than many thought. Rijo continues to be involved in baseball in the Dominican Republic.
Early '90s: Mariano Rivera
This period of the early '90s contains one of the most interesting pieces of trivia about the history of pitching: Mariano Rivera was long thought to be a Tommy John survivor, but it turns out, he did not have the classic procedure.
Jobe opened up his elbow in 1992, trying to learn if a slider damaged his UCL, but the ligament was not torn enough to replace. Instead, Jobe cleaned up the damaged ligament, moved the ulnar nerve and closed him back up.
There's still some debate about what to actually call this surgery, but any way you look at it, it's amazing to think that Rivera's career almost didn't happen.
Late '90s: Kerry Wood
Before: One year in MLB with Cubs; 13-6 record with 3.40 ERA and 233 strikeouts in only 166.2 innings.
After: Continued injury problems; 14 trips to DL in 13 seasons; not a single complete game after four in 2003; 86-75 record and a 3.67 career ERA.
Of note: Kerry Wood became a star after exploding onto the scene with a 20-strikeout game in his rookie year, only to head under the knife and miss the next.
Wood had been a Texas schoolboy phenom, but like many, he was vastly overused. He even threw both games of a doubleheader during the Texas playoffs, just after being drafted by the Cubs.
Wood was able to return from surgery, but his mechanics and violent delivery caused him further elbow and shoulder problems throughout his career. Of course, the overuse never really stopped either. Wood and teammate Mark Prior continue to be the tipping point for baseball when it comes to pitch counts, but their example hasn't led to a reduction in injuries.
Late '90s: Jason Isringhausen
Surgery: 1997, 2008, 2009
Before: Solid prospect became respectable major league pitcher; 2.81 ERA in first season; slipped a bit in 1996 with 4.77 ERA and then 7.58 ERA in six starts in 1997.
After: Became solid closer for majority of career; an even 300 career saves, including 47 in 2004 while with the Cardinals; somehow managed to keep pitching until 2012.
Of note: Part of the Mets' vaunted "Generation K," Jason Isringhausen, along with Bill Pulsipher and Paul Wilson, might have been more accurately called "Generation TJ." The Mets' overuse of their three young pitchers led to arm injuries and shortened careers.
For Isringhausen, perhaps it wasn't shortened as much as it was changed. He changed his role, his mechanics and his style, but he was not able to overcome further injuries, despite a solid career as a closer.
Isringhausen was one of the early experiments in swapping injured starters to the relatively new closer role. Baseball has shown us that this is not a safer role, with the percentage of relievers needing the surgery very similar to the rate for starters, despite early successes by Isringhausen and John Smoltz.
Early 2000s: John Smoltz
Before: Four-time All-Star; Cy Young winner in 1996 with 24-8 record and 2.94 ERA along with 276 SOs.
After: Became dominant closer for three seasons, recording 144 saves, with 55 coming in 2002; solid starter for three more years after that; ended career with 213-155 record, 3.33 ERA and 154 career saves.
Of note: John Smoltz is likely to be the first Tommy John pitcher enshrined in the Hall of Fame, as soon as 2015.
As a starter for the Braves, Smoltz teamed up with Tom Glavine and Greg Maddux in one of the greatest rotations in history. The difference between Smoltz and the others is that his elbow didn't hold up, forcing him to the pen and costing him a chance at 300 wins.
It's symbolic of how many pitchers now are getting this surgery—three great pitchers, all with similar results, but one-third of them needed elbow surgery.
Early 2000s: Nick Adenhart
Before: A brilliant high school career was almost wiped out by injury, but a bold move by the Angels gave them one of the best young prospects in their team's history.
After: After breezing through the minor leagues after surgery, Nick Adenhart was quickly becoming a solid one-two punch with Jered Weaver. He was killed by a drunk driver in 2009 just after he'd locked down a starting role for the team.
Of note: Adenhart's career was cut off too soon, but it's the start of his career that is intriguing for this story.
He was drafted by the Angels despite the team knowing that he would need Tommy John surgery after an injury late in his senior year of high school. Angels scouting director Eddie Bane took a chance on Adenhart and on the Angels team physician, Dr. Lewis Yocum.
A sizable bonus bought Adenhart out of a scholarship to North Carolina, and he spent his first season as an Angel rehabbing from his elbow reconstruction. Adenhart made his minor league debut almost exactly a year after the surgery and quickly made it to the majors.
Tragically, he was killed in 2009 and never had the chance to show us just how good he could have been. Today, more and more teams are willing to take chances on young pitchers with arm injuries.
Late 2000s: Chris Carpenter
Before: Two All-Star spots; Cy Young in 2005; made big break after move to Cardinals, going 51-18 in first three seasons (2004-2006).
After: Injuries hindered 2007-08 seasons, but he’s still been effective when healthy; career-best 2.24 ERA in 2009; All-Star in 2010; 144-94, 3.76 ERA 1,697 strikeouts for his career.
Of note: Chris Carpenter's early career was stunted by shoulder injuries. The Blue Jays passed him along after they were unsure whether or not he could recover from surgery.
The Cardinals took a shot, spending a full season rehabbing him, getting a great five-year run in return. His elbow gave way in 2007, and while he was able to come back and play, he's seldom been healthy, requiring more shoulder surgery.
He's currently attempting yet another comeback, but the fact that he's been able to do anything in the game is a testament to sports medicine. That he's been able to have no real problems with his elbow since Tommy John surgery reminds us that fixing the elbow is vastly easier than fixing the shoulder.
While there is a similarly named shoulder surgery, also created by Jobe, the term "Orel Hershiser surgery" is not a common one. The surgery that helped Hershiser return from rotator-cuff reconstruction did help Carpenter as well.
Late 2000s: Jarrod Parker
Before: Minor leaguer who was slowly rising up farm leagues before hurting elbow in Double-A.
After: Still early in his career, but not looking too bad so far; 13-8 record in 2012 with a 3.47 ERA and 140 strikeouts; currently 6-6 with a 3.95 ERA in 2013.
Of note: Jarrod Parker is an interesting case. Just as Adenhart was one of the first pitchers who showed that Tommy John surgery shouldn't make teams hesitate in drafting a pitcher, Parker became one of the first pitchers to clearly show that losing a year to rehab from surgery may not slow down a pitcher's development.
When Parker had surgery, he was essentially able to continue development while rehabbing. Many doctors and therapists have theories about this, including the fact that these young pitchers are growing and developing physically during the process, as well as getting rest and strengthening their arms for their eventual returns.
Parker's career was not sidetracked by surgery, and his example has made it possible for many others to do the same. Moreover, he was acquired by the A's after returning, reminding teams that acquiring a post-TJS pitcher is hardly a risk at all.
Early 2010s: Stephen Strasburg
Before: Selected No. 1 overall in the 2009 MLB draft by Nationals; rookie deal for four years and $15.1 million; 5-3 record with 2.91 ERA and 92 strikeouts in 68 innings in 2010 before being hurt.
After: Still looks like he can be one of the more dominant pitchers; he is 20-13 with a 3.09 ERA and 306 strikeouts in almost 268 innings.
Of note: Stephen Strasburg was one of the most heralded pitching prospects in history. His dominance at San Diego State made him a no-doubt No. 1 pick by the Nationals and a cornerstone of their franchise.
They were exceptionally conservative with him as he blitzed through the minor leagues, but even that couldn't save his elbow. He blew it out in his rookie season and had it repaired by Yocum. It was after the surgery where things got controversial.
The team stuck by its plan to hold his innings down by shutting him down early in 2012 and not bringing him back for the playoffs, despite Strasburg saying he was ready to contribute (the Nats lost 3-2 to St. Louis).
Strasburg has never had a biomechanical study done, so we don't know the forces that high-90s fastball put on his elbow. Whether or not the Nats can keep him healthy may be key in whether or not the franchise gets more shots at playoff success.
Early 2010s: Adam Wainwright
Before: Third in Cy Young with 19-8 record and 2.63 ERA in 2009; All-Star in 2010 with a 20-11 record, 2.42 ERA.
After: 2012 didn’t look like the “old” Wainwright (14-13 3.94 ERA), but 2013 is looking a lot better (12-5 2.45 ERA, four complete games).
Of note: The Cardinals can't have both Carpenter and Adam Wainwright healthy at the same time, it appears. While the team showed it can win without its ace, putting another World Series trophy under the arch as Wainwright rehabbed in 2011, it has been an issue for the franchise over the last decade.
Besides Carpenter and Wainwright, the franchise that became known for Dave Duncan's pitcher renovations also became a place where far too many pitchers ended up on a surgeon's table. Jaime Garcia and Jason Motte also have recent scars, which makes one wonder how good this team could be if it was just a little healthier.
With a new medical staff that joined manager Mike Matheny, we may yet find out.
This article is part of a package of multimedia stories about Tommy John surgery. Click these links for more:
- The history and impact of Tommy John surgery.
- How the surgery is done, and the major questions surrounding it.
- The surprising number of current pitchers who've had Tommy John surgery.
Will Carroll has been writing about sports injuries for 12 years. His work has appeared at SI.com and ESPN.com, and he wrote "Saving The Pitcher." Tyler Brooke provided invaluable assistance with this piece. All interviews and research done firsthand, unless otherwise indicated.