I attended my grandson’s baseball game last week and overheard that his pitch count was 38 after two innings. What that means nowadays is that during the next inning he would need to be replaced since the 50-pitch limit would be enforced. The care and concern for youth pitchers today is on high alert. When I was about his age, there was no such thing as pitch counts or innings limits. If you were the team’s pitcher, you got the ball. The only care we received was through home remedies. I recall my Dad putting in a chin up bar in our basement so that I could stretch out after outings. I didn’t care for that bar very much. In addition, I would take salt pills to restore the weight I lost pitching in a game during hot summer days. One name changed the rules for all of us who have had the enjoyment of pitching – Tommy John.

In 1974, after years of study by Dodgers’ team physician and orthopedic surgeon, Dr. Frank Jobe, Dodger pitcher Tommy John became the first patient of Jobe’s to undergo ulner collateral ligament (UCL) reconstruction (now known appropriately as “Tommy John Surgery”). Dr. Jobe took a tendon from John’s wrist, drilled holes into his ulna and humerus bones, and grafted the tendon in a figure-eight design held together by anchors. It was truly experimental surgery meant to counteract John’s persistent pain in his left, throwing elbow. It wasn’t until 1978 when the next Tommy John Surgery would be performed by Dr. Jobe.

The surgery was very meaningful in John’s pitching career. In 1961, at 18 years old, Tommy John was signed by the Indians because of his dynamic curveball. He debuted in the MLB with Cleveland in 1963, and then was traded to the White Sox. 1965 was his first year as a full-time starting pitcher. His career took off in 1968 when he was named an AL All-Star and posted a 1.98 ERA. Traded to the Dodgers in 1972, John led the National League in winning percentage in 1973 (.696) and 1974 (.814) before his ’74 season abruptly ended when he tore his UCL. You might recall another Dodger pitcher with a terrific curveball a decade before whose career prematurely ended with elbow ailments, Sandy Koufax. Dr. Jobe often remarked that if the surgery had been developed years earlier, it would have been known as “Sandy Koufax Surgery”. In any event, the 1974 surgery prolonged Tommy John’s career for 15 more years, as he retired in 1989 with a career 288-231 win-loss record, 3.34 ERA, and four All-Star nods.

Tommy John Surgery has been a career saver for many MLB pitchers. Foremost among them is Hall of Famer John Smoltz. Smoltz played in 21 MLB seasons, all but the last one with the Braves. Smoltzie began his career in 1988 as a starter, one of Atlanta’s dominant three along with Greg Maddux and Tom Glavine. The threesome led the Braves to the 1995 World Series championship. The next year Smoltz won the NL Cy Young with a record of 24-8. In 2000, he underwent Tommy John Surgery. His mound comeback in 2001 saw him outside the Atlanta rotation and in a new role as the team’s closer. Close, he did, recording 55 saves in 2002, becoming only the second pitcher in MLB history to have both a 20-win season and a 50-save season. Dennis Eckersly is the other one.

Another HOF’er who had successful Tommy John Surgery was actually a position player, Paul Molitor. Molitor’s 21-year playing career (1978-1998) included fifteen years with the Brewers, but also three years with both the Blue Jays and Twins. Most of his acolades occurred after his Tommy John Surgery in 1984. Molitor was a 7-time All-Star and the World Series MVP in 1993. Throughout his career he was known for his hitting prowess (lifetime batting average of .306) and speed (504 stolen bases). The only other Hall of Famer who had Tommy John Surgery was relief pitcher Billy Wagner, who starred principally for the Houston Astros.

While rare, some players unfortunately never recovered from Tommy John Surgery. Jose Rijo of the Reds tops that list. From 1988 to 1993, Rijo was one of the supreme pitchers in baseball, on the leaders’ lists in ERA, strikeouts, and wins each year. He is most known for leading Cincinnati to an upset, four-game sweep of Oakland in the 1990 World Series, where Jose’s Games 1 and 4 dominance secured him the Series MVP award. Elbow injuries sidelined him in 1995 and he had the surgery in August that year. While Rijo came back to pitch in portions of 1997-2001, he was never the same.

Since the first Tommy John Surgery in 1974, almost 2,500 professional baseball players have undergone the procedure. Indeed, approximately 38% of active MLB pitchers today have had it. The percentage continues to grow; about 27% of MLB pitchers a decade ago had it. Those numbers don’t even including the individuals who have had more than one procedure. 30% of the patients need a second one along the way. While those are alarming statistics, the prevalence of the surgery on our youth is staggering. Around two-thirds of Tommy John Surgeries are performed on athletes between 16 and 20 years old. Some patients have even been in Little League.

The rise in these surgeries is the result of many things, but mostly due to the intensity of higher velocity pitching. Throwing a baseball, especially pitching one, is not a natural motion. In one of the leading medical articles, “What Doctors Wish Patients Knew about Tommy John Surgery”, Sara Berg in 2024 points to the prevailing research that the harder one throws a baseball, there is more torque and stress on the elbow. Yet, we keep upping the game and demanding that pitchers throw harder and harder. And the fix just can’t be to just have the surgery. Dr. Vasilios Moutzouros, an orthopedic surgeon at Henry Ford Health and a leading expert, says this in Berg’s report: “It’s not the easiest surgery because the elbow is a really difficult joint to operate on.” While the success rate is high (90% get back to throw), outcomes are worse with each additional procedure and the recovery time is lengthy (12-16 months).

How does baseball prevent the injury? For our youth, warming up properly, rest, limiting pitches and innings, and playing other sports are part of the recipe. At the professional level, the careful development of pitchers through the system is at the forefront of everyone’s mind. Yet, the injuries continue to mount and seasons are lost. Most recently, the Cubs’ pitching phenom, Cade Horton, underwent his second Tommy John Surgery and is projected to be out of action until sometime late next summer. It’s a plight that many pitchers and teams at all levels continue to have.

Until next Monday,

your Baseball Bench Coach