Dr. Frank Jobe at the Kerlan Jobe Orthopedic Clinic in Los Angeles to save the career of an aging pitcher (Tommy John was 31 when the first surgery was performed in 1974 and had won 124 games, he missed almost two complete seasons and won another 164 games before retiring in 1989 a the age of 46). He went from an aging pitcher to an ageless pitcher. At the time Dr. Jobe gave the surgery's chances of success at 1 in 100. Pitchers now see a success rate of 92%.

Tommy John surgery, more properly known as ulnar collateral ligament reconstruction (or UCL), is a surgical operation in which a ligament in the medial elbow is replaced with a tendon from elsewhere in the body (often from the forearm, hamstring, or foot of the patient).

The patient's arm is opened up around the elbow. Holes to accommodate a new tendon are drilled in the ulna and humerus bones of the elbow. A harvested tendon, such as the palmaris tendon from the forearm of the same or opposite elbow, the patellar tendon, or a cadaveric tendon, is then woven in a figure-eight pattern through the holes and anchored. The ulnar nerve is usually moved to prevent pain as scar tissue can apply pressure to the nerve.

The surgery has become career saving for many oft he top young pitchers in the game today. Many recover feeling strong and appearing the throw harder. However, Dr. Jobe (1925-2014) believed it allowed pitchers to believe any post-surgical increases in performance are most likely due to the increased stability of the elbow joint and pitchers' increased attention to their fitness and conditioning. Jobe believed that, rather than allowing pitchers to gain velocity, the surgery and rehab protocols merely allow pitchers to return to their pre-injury levels of performance.

The increased amount of throwing that young pitchers do, the fact that players specialize in one sport more than they did in the past, the number of games young players play compared to the past with the advent of increased high level travel team competition and the training methods used to give players more overall body strength are all contributing factors in the increased frequency of Tommy John surgeries.

Mike Pelfrey, Matt Harvey, Yu Darvish, John Smoltz, Stephen Strasburg, AJ Burnett, Josh Johnson, Chris Carpenter, John Lackey, Joba Chamberlain, Adam Wainwright, Jacob deGrom, Kerry Wood, Ivan Nova, Jordan Zimmerman, and Jose Fernandez are just a few of the noted high profile pitchers who have had Tommy John surgery. 

In past years, players threw more and seemed to be injured less. You'll hear many great players from the past say that the best training for baseball is playing baseball and performing baseball movements not specialized gym training. In the ever high stakes financial game of modern sports performance trumps all and everyone is looking for an edge. A serious reconstructive surgical procedure like Tommy John surgery is just another detour on the road to success.

It seems like Tommy John surgery for Major League pitchers has become a rite of passage. What was originally an innovative surgery performed by