Stephen Strasburg returns to a major league mound for the first time in over… (Jonathan Newton/WASHINGTON…)
The baseball world will take a break from its pennant races Tuesday night and watch Stephen Strasburg hurl fastballs at close to 100 mph, mesmerized again with his talent. It will possess only a vague understanding of the medical advances that allowed him to do so now and, the Washington Nationals hope, for years to come.
Strasburg will return to the major leagues one year, one month and 16 days after he threw a change-up and snapped the ulnar collateral ligament in his right elbow. One year ago Saturday, Lewis Yocum bored holes in a bone in Strasburg’s elbow and attached to it a tendon removed from Strasburg’s thigh. Over time it transformed into a replacement ulnar collateral ligament, a thin strand of tissue that gave Strasburg new pitching life.
The procedure known as Tommy John surgery has changed baseball for 37 years, ever since Frank Jobe performed the first ligament-replacement surgery on the left-handed pitcher for which the operation is named. A torn UCL was once a death sentence for pitchers’ careers. Tommy John surgery was once regarded as a risky, last-resort operation. It has become commonplace and, at the highest level of baseball, a virtually sure-fire means to restore a pitcher’s career.
“As long as it’s in the right hands,” said Tim Kremchek, a leading Tommy John practitioner, “the player has over a 95 percent chance of coming back.”
The surgery Strasburg underwent last year struck a devastating blow to the Nationals’ 2011 hopes and presented Strasburg a grueling year of rehabilitation. But because of the evolution and prevalence of Tommy John surgery, Strasburg will join the horde of major leaguers who have returned with a four-inch scar on the inside of their pitching elbow.
“I would never have thought it would happen,” said Jobe, the orthopedic surgeon who pioneered the surgery. “It’s been a very fortunate experience for me. It just turned out very well.”
Tommy John met Jobe in 1972. John was pitching for the Los Angeles Dodgers and needed bone chips removed from his left elbow. Jobe, then the Dodgers’ team physician, performed the surgery. They stayed in touch. Jobe performed an operation on John’s wife. A friendship formed.
Late in the summer of 1974, John felt a pain in his left elbow so severe he could no longer pitch. He learned he had snapped the ulnar collateral ligament. He went to Jobe.
Early in his career, Jobe had performed tendon grafts for children who had polio diagnosed. When he examined John’s torn ligament, the idea to perform a similar operation struck him.
“Immense creativity,” said Yocum, the surgeon who performed Strasburg’s operation and now practices with Jobe.
“Brilliant,” Kremchek said.
At the time, Jobe was confident but was not certain the idea would work.
“I trusted Jobe,” John said. “He was a friend. I knew he wouldn’t BS me. He would lay it on the table and tell me what was good for me. He told me, ‘You do not have to have the surgery. But if you don’t, you will never pitch again.’ I said, ‘Okay, if I have the surgery, what are the chances?’ He said, ‘You probably won’t pitch again.’ I wanted to play baseball. I would do whatever it took to play baseball again. So we had the surgery.”
When Jobe operated, he sliced John’s elbow wide open and moved the ulnar nerve in order to reach the bone. He took a tendon from a cadaver’s leg and attached it with screws. Then he hoped John’s body would react favorably and the tendon would serve the same role as the ligament.
“We didn’t really know whether we could do it or not,” Jobe said. “We didn’t know whether we could heal it or not. We didn’t know whether a tendon would be accepted by the body and receive blood supply and become part of the body.”
Jobe and John waited. John did not throw a ball again for 16 weeks. Jobe decided he should not pitch in a major league game again until one year of rigorous rehab. Every step of the way, the recovery unfolded as Jobe hoped. John returned in 1974, and in seven of the next eight seasons he threw more than 200 innings.
“I would never have thought it would happen,” Jobe said. “I didn’t do it again for another two years. After another year or so, I had a couple successes. I thought, ‘This may be something we ought to use a little more routinely.’ ”
Tommy John surgery has become more reliably successful, and so more pitchers have had it. As more pitchers undergo the surgery, doctors are able to perform more studies and gain more knowledge, and it becomes more reliably safe.
Last year, 10 pitchers who had undergone the surgery were named to the all-star team. Kremchek, the Reds’ team physician, said he once performed 15 to 20 ligament-replacement surgeries per year. In 2010, he performed Tommy John surgery about 150 times.