Examining Tommy John surgery, part 1

Most everyone has at least heard of Tommy John surgery, but here is a look at the process that is now talked about without explanation.

Writer's Note: Chase Parham, a left-handed high school pitcher, underwent Tommy John surgery on August 1, 2001. This is the first part of a two-part series on the process. Part one gives the basics of the surgery, while part two will discuss the four Ole Miss pitchers that have lived the procedure.

Hearing the term ulnar collateral ligament reconstruction may be a foreign phrase to most baseball enthusiasts, but the aptly named Tommy John surgery is even in the causal fan's vocabulary.

The readily available procedure gives injured pitchers a second chance and is distinguishable by the four-inch scar that is visible on the player's throwing elbow. Many college and professional clubhouses contain at least one pitcher that has experienced the procedure.

Ole Miss is no different as the Rebels feature four athletes with the elbow surgery in their past. Will Kline, Brett Bukvich, Phillip Irwin and Justin Cryer are all past recipients that have given the Rebels productive outings this season.

"It has always been a pretty successful procedure for the most part," Rebel baseball trainer Tony Barnett said.

The revolutionary procedure was first performed in 1974 by Dr. Frank Jobe and named after Tommy John, a pitcher for the Los Angeles Dodgers that was the first professional athlete to successfully undergo the process. John was diagnosed with "dead arm", but he looked for an alternative to the injury that ended many pitchers careers including Sandy Koufax.

Following surgery, John spent 18 months rehabilitating before pitching 14 seasons and winning 164 more games.

The injury occurs when the ulnar collateral ligament in the elbow becomes frayed or torn and is repaired by replacing the ligament with a tendon from another part of the body. The underside of the forearm is the most common area that a tendon is taken from, but it isn't the only one. A certain percentage of the population doesn't have that particular tendon so one from the hamstring, knee or foot can also be used. Cryer used a tendon from a medical cadaver.

"I don't have these," Cryer said, pointing to his forearms. "So I chose to take one from a cadaver. It took a couple weeks to prep, but when it was ready, the doctor stuck it in."

After locating a suitable replacement tendon, it is grafted into the elbow by being woven in a figure-eight pattern through tunnels drilled in the humerus and ulna bones. The procedure takes approximately an hour and doesn't always require an overnight hospital stay.

The first step is for the body to convert the ligament into a tendon. (A ligament connects bones, stabilizing a joint. A tendon attaches muscle to the bone.) It is very weak immediately after the surgery, and the rebuilding process must be gradual.

Many pitchers perform the same or better following the surgery, but that is more because of the intense rehab than the actual reconstruction. The elbow is placed in a hard brace right after surgery before attempting to regain limited motion during the second week.

The first three months of rehab are spent using stretching tubes and other tools in order to regain flexibility and range of motion. Afterward, a throwing program is introduced, but the process isn't nearing completion.

Most setbacks occur during the throwing program due to a false sense of security because of the arm feeling healed. The majority of the programs slowly stretch the throwing distance from flipping the ball to long tossing before allowing the pitcher to throw off a mound. Most players don't have any pain and have complete range of motion within a year, but the full recovery time normally ranges from 18-24 months.

A number of pitchers complain of a lack of rhythm and not being able to "feel the pitches" after the throwing program is complete but before the 18-24 month period has been reached.

The increase in technology and knowledge on the rehabilitation side has increased the success rate from 60 percent to 85-90 percent over the past 15 years according to surgeon James Andrews, who was interviewed by USA Today.

"A lot of kids come back better because over time the ligament had become so stretched out that they were losing velocity," Barnett said. "Most are stronger also because of the long rehab and also the strength exercises that occur. Also, a great importance is put on mechanics because the player has to re-learn everything."

The technology has also opened up the availability of the process. The majority of the cases are performed on high school and college athletes instead of professionals.

"It is all about doctors getting more comfortable," Ole Miss head coach Mike Bianco said. "The more you see it, and the more it is around, then the more people that have access. Technology is what it is about."

And this access and process has kept alive the pitching careers of four Rebels.

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