Robbie Ray Underwent Tommy John Surgery, But What is It?

“Tommy John Surgery” is a lot easier to say than “Ulnar Collateral Ligament Reconstruction,” the procedure's medical and more descriptive name.  Primarily, pitchers need this surgery, but some other baseball players and competitors from other sports also need UCL reconstruction. Bryce Harper, an outfielder, recently returned to the Phillies after having the procedure last Fall.

A short review of the arm and elbow basics begins with the humerus, the upper arm bone. Two bones are in the forearm: the radius on the outside of the elbow and the ulna on the inside of the elbow. The forearm's two bones, in connection with the elbow joint, allow a pitcher to grasp the ball and throw it in various ways at high speed while it spins.

The UCL connects the humerus to the ulna. Dr. Frank Jobe first completed a UCL reconstruction in 1974 on Tommy John’s elbow. He intended to repair a tear in the UCL but could not find any left when he looked inside. Doctors may find part of the UCL or torn pieces of it. In reconstruction, surgeons take a tendon from elsewhere in the patient’s body, drill holes in the ends of the humerus and ulna, and weave the tendon on a graft through the holes and secure it to the bones.

When the Mariners thought that Robbie Ray had a flexor tendon strain, an overuse injury, they thought that rest could be a treatment, but it wasn't enough. His surgery repaired a tendon as well as reconstructed the UCL. Tendons connect muscles to bones. Surgeons usually sew torn ends of a tendon together, reattach the tendon to the bone, or replace it entirely with another tendon from the body. Tommy John surgery is also an overuse injury that comes from repeatedly using the same bones, muscles, tendons, and ligaments in the pitching arm for practice and games. The need for TJ surgery does not mean that a pitcher has not taken good care of his arm.

Approximately one-quarter of MLB pitchers will have this procedure done during their career. Mariners’ reliever, Justin Topa, had the procedure done twice. Recovery time for pitchers from Tommy John surgery varies but usually takes twelve to eighteen months. The patient wears a brace for a period, has much physical therapy, and is forbidden to throw a ball for a while.

I looked at updates about MLB pitchers who had TJ surgery a year ago.  Andrew Kittredge, Casey Mize, and Max Kranick had their surgeries in June. Kittredge will not return to the Rays until at least mid-season. Mize began a program for throwing in February. Kranick plays catch a few times a week. The Orioles’ John Means, whose surgery was in April of last year, has been throwing 30 pitches every week and will likely return to the team in July.

Tearing the UCL before 1974 usually meant the end of a pitcher’s career. I am curious about what percentage of pitchers would have needed TJ surgery in the sixties and early seventies. Could the faster pitches used today have increased the number of damaged UCLs?

Those who tuned in to Mariners’ Spring Training likely heard that Robbie Ray worked hard during the offseason to be in shape. He had increased his velocity and added a splitter.  Stepping back from baseball is likely frustrating.  I hope that Ray and his fellow recovering pitchers find opportunities and rewards during their time away.