The Alarming Increase in MLB Pitchers Who've Had Tommy John Surgery

Will Carroll@injuryexpertSports Injuries Lead WriterJuly 17, 2013

One-third of current MLB pitchers have had Tommy John surgery. Of the about 360 who started the season, 124 share the all-too-familiar triangular scar. 

How surprising is this number? It stunned me! In recent talks with baseball officials, none guessed more than the one-in-nine number I had often seen quoted over the last decade (and quoted myself). Worse, none of us had any idea when this change had happened or noticed the acceleration. 

With the help of research assistants, I arrived at the number 124 by going through current rosters and searching news reports for each pitcher, looking to see if he had had Tommy John. The players are listed in this PDF, along with the year of their most recent surgery (players with italicized years have had more than one elbow reconstruction). For a different look at all the names, check out the illustration below.

Why is the number so high? Among the top doctors in sports today, there are theories. It starts with the top reason cited by Dr. Frank Jobe, the creator of Tommy John surgery.

"Overuse," he said plainly. 

Bleacher Report's tabulation of current pitchers who've had Tommy John is part of a package of stories about the surgery and Jobe, who will be honored at the Baseball Hall of Fame ceremonies in late July. Also in the package are the history and legacy of Jobe and Tommy John, a detailed look at the realities and myths of the surgery and profiles of notable cases over the past four decades.

While pitch counts and innings totals during the season have gone down over the last 40 years, since Jobe first did the procedure, year-round pitching at youth levels has increased dramatically. Renowned sports surgeon Dr. James Andrews often points to this lack of rest as a major reason for the increase in surgeries. His program calls for two or three months off from throwing, though he encourages participation in other sports. 

Across sports medicine, almost all doctors agree that this is an overuse problem that starts at a young age. Dr. Tim Kremchek performed Tommy John surgery on two pitchers who had gone to the Little League World Series the previous season. At just 14 years old, these young athletes surely enjoyed reaching the peak of the Little League game, but at what cost for the effort it took to get there?

The push of surgeries to younger pitchers is also creating more time for reconstructed ligaments to fail, making more surgery necessary.

Research I did in 2006 led me to the concept of the "Tommy John honeymoon." I found that five years after surgery, there were very few additional elbow problems, which indicated the transplanted ligament was stronger. Further research showed that the process called ligamentization was at work.

However, after the five-year period, the tendon becomes a normal ligament, subject to the same kind of overuse injuries. With so many pitchers getting a first surgery, often when they're quite young, there's a greater chance a second surgery will be necessary.

Just last season, former elite closers Joakim Soria and Brian Wilson underwent second surgeries. Pitchers have undergone third, fourth and even fifth Tommy John surgeries, though these are very rare.

The increase in the procedure comes down to the availability of a workable procedure that keeps younger pitchers in the game. A generation ago, most pitchers with elbow problems were forced out of the game. 

It is clear the game is better because of a miraculous surgery that nearly guarantees the return of pitchers who would have been done otherwise. What is equally clear is baseball as a whole has no idea how to stop this rapid acceleration of arm injuries. The number 124 is proof.

This article is part of a package of multimedia stories about Tommy John surgery. Click these links for more:

Will Carroll has been writing about sports injuries for 12 years. His work has appeared at SI.com and ESPN.com. His book "Saving the Pitcher" was published in 2004. 

Tyler Brooke, Stacey Gotsoulias and Joel Henard provided invaluable research assistance for this project. All interviews and research conducted firsthand, unless otherwise indicated. 


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