The rise in Tommy John surgeries

April, 24, 2014
Apr 24
3:12
PM ET
Josh Johnson's elbow problems carried over from his Toronto Blue Jays days in late 2013 to his 2014 spring with the San Diego Padres. An offseason scope was followed by a flexor strain this spring, ultimately becoming an ulnar collateral ligament injury. On Thursday, Johnson underwent Tommy John surgery, his second, with Dr. James Andrews.

The numbers continue to rise in what may be turning into a record year for UCL reconstructions, usually referred to as Tommy John surgery. It’s too early to say the numbers for this season will outdo those of 2012 (which holds the record for the most Tommy John surgeries, at 36) or even last year’s number of 19, but with the number for 2014 standing at 14 as of the third week in April (with 15 on the horizon when Yankees pitcher Ivan Nova undergoes the procedure), anything is possible.

What does seem to have already outpaced any other year is the number of second Tommy John surgeries, referred to as revision UCL surgery in the medical arena. Johnson is the latest player to opt for a second such elbow surgery, increasing the number of revisions in MLB players to seven in the past 12 months. For perspective, consider that before 2012 there had been fewer than 20 UCL revisions performed in the previous 15 years.

Why the dramatic rise? The short answer is that we simply don’t know. There are multiple theories -- success of a first procedure encourages players to opt for a second rather than retire; players are tearing their ligaments at a younger age, making a second injury while still in their prime more likely; the reconstruction was never meant to hold up to a lengthy career of pitching, etc. -- but a scientifically based answer is not likely to come for some time, as the total sample size remains relatively small. Even Tommy John himself is alarmed by the numbers, and he emphasizes a point the medical world would like to draw more attention to: Kids are pitching year-round, resulting in overuse injuries at an increasingly younger age.

While there are many more questions than answers with regard to the management of this elbow-injury epidemic in professional baseball, there is one area where a collective effort can make an impact: youth baseball. It is incumbent upon everyone -- parents, coaches, scouts, medical providers -- to make an effort to alter the trajectory of these numbers at the youth level, if for nothing more than the health of young arms.

Just imagine for a moment if the trend could be reversed. Besides healthier kids, the potential ramifications could extend into the professional baseball world. Who knows? There might be a whole layer of talented players out there who could actually endure a professional career without being repeatedly derailed by injury, presuming they’re given the chance to start that career healthy.

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