'Tommy John' surgeries have risen sharply in teenage baseball players

By John Murphy, MDLinx
Published March 9, 2016

Key Takeaways

The number of “Tommy John” procedures—or ulnar collateral ligament reconstruction of the elbow—have increased nearly 200% in the past decade, particularly among older teens and young adults, according to a study published online January 21, 2016 in the American Journal of Sports Medicine.

Many of these procedures can be attributed to pitching-related elbow injuries in teenage baseball players, said study leader Christopher S. Ahmad, MD, Professor of Orthopedic Surgery at Columbia University Medical Center (CUMC), head team physician for the New York Yankees, and Chief of Sports Medicine at NewYork-Presbyterian/Columbia, in New York, NY.

Named for the Los Angeles Dodgers pitcher who had the first procedure in 1974, Tommy John surgery involves replacing a torn or ruptured ulnar collateral ligament (UCL) with a tendon from another part of the body. In 2015, 31 major league pitchers had Tommy John surgery, 11 of whom had the surgery for the second time, according to MLB.com.

“Everybody who follows baseball is worried about the rise in Tommy John procedures in the major leagues, and rightly so,” Dr. Ahmad said. “But we should also be worried about the 6 million children and young adults in the US who play this game and are at risk for significant pitching-related injuries. We need to determine why these injuries are so common and what can be done to prevent them.”

For this study, Dr. Ahmad and colleagues reviewed data from the New York Statewide Planning and Research Cooperative System to find that 444 patients in New York State underwent UCL reconstruction between 2002 and 2011. During that period, the total volume of UCL surgeries increased by 193%, while the number of UCL reconstructions per 100,000 people tripled from 0.15 to 0.45. Almost all of the growth occurred in two age groups, 17- to 18-year-olds and 19- to 20-year-olds. The average age of patients, who were predominantly male, was 21.

There was also a 400% increase in concomitant ulnar nerve release/transposition procedures during the study period—a significant increase in the frequency of ulnar nerve procedures at the time of UCL reconstruction, researchers noted.

The study didn’t address the reasons why UCL reconstructions have increased, but Dr. Ahmad speculates that a major factor is the fiercely competitive culture of youth baseball, which encourages players to throw more frequently, with greater intensity, and at a younger age. “Whatever the cause, we now know for certain that more kids are getting injured,” he said. “We should be asking ourselves what we can do to prevent these injuries.”

In a 2014 study, Dr. Ahmad found that three-quarters of young players reported having arm pain while throwing, and almost half of all players had been encouraged at least once to continue playing despite having arm pain.

“If a young player is hurting, he or she should not keep playing or pitching,” Dr. Ahmad said. “Kids, of course, think they’re indestructible. Parents and coaches are in a position to tell athletes when it’s time to give the arm a rest and if they need to take a temporary break from baseball.”

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