Tommy John Surgery (TJS), formally known as ulnar collateral ligament (UCL) reconstruction, has become a common narrative in the world of baseball. Athletes and fans alike often view the procedure as a surefire fix for pitchers dealing with elbow injuries, with many believing it not only restores health but can even improve performance, particularly velocity. Some go so far as to think it’s almost guaranteed that a pitcher will return to peak performance, stronger than ever.
But the reality is far more complex. While Tommy John Surgery has undoubtedly saved many baseball careers, it is by no means an easy fix or a guaranteed path to success. In this article, we’ll dive deeper into the myths surrounding the surgery, the actual outcomes athletes can expect, and the challenges they face during recovery and beyond.
The Origins of Tommy John Surgery
Before debunking the myths, it’s important to understand the origins of TJS. The surgery is named after Tommy John, a Major League Baseball (MLB) pitcher who, in 1974, became the first athlete to undergo this pioneering procedure. Performed by Dr. Frank Jobe, the surgery involved reconstructing the UCL in John’s pitching arm using a tendon from elsewhere in his body. The success of the surgery allowed Tommy John to return to the MLB and extend his career by several years, sparking widespread adoption of the procedure.
Since then, Tommy John Surgery has become a standard treatment for UCL tears, particularly among baseball pitchers. The procedure involves replacing the damaged UCL with a tendon, often taken from the patient’s own body, such as from the forearm or hamstring, though cadaver tendons can also be used.
The Myth: A Guaranteed Fix for Velocity and Performance
One of the most common myths surrounding Tommy John Surgery is that it’s an easy fix, not only for repairing an injured arm but for improving performance—specifically, increasing pitch velocity. This belief likely stems from the success stories of some high-profile pitchers who returned from TJS with excellent performance, leading others to think that the surgery itself can lead to improved results.
Unfortunately, this is not always the case. While there are pitchers who have returned stronger and more effective post-surgery, the surgery itself does not enhance an athlete’s physical abilities beyond their pre-injury state. Any perceived improvements are often a result of better mechanics, increased strength from rehabilitation, or even mental resilience developed during the recovery process.
The Reality: Return-to-Play Statistics Tell a Different Story
Let’s break down the statistics, because they tell a very different story than the one perpetuated by popular belief. It is true that many athletes do return to play after Tommy John Surgery. In fact, prior studies report that 90-97% of athletes are able to return to baseball following the procedure. However, these numbers can be misleading.
When these studies refer to "returning to play," they are often measuring success as simply being able to throw a single pitch in a game—whether in the minor leagues or major leagues. They do not necessarily reflect the athlete’s ability to return to their pre-injury level of performance or their long-term success in the sport.
A closer look at the data reveals a more sobering picture. A 2021 study led by Matt Fury and colleagues took a deeper dive into the return-to-prior-level-of-performance rates. Their findings showed that out of 63 MLB pitchers who underwent Tommy John Surgery between 2015 and 2019, only 36 (57.1%) returned to the MLB, and only 32 of those pitchers were able to throw more than 100 pitches in any one season post-surgery. This means that 27 pitchers, or 42.9% of the sample, never made it back to Major League Baseball.
These numbers highlight the real challenge of returning not just to the game, but to the level of competition and performance that athletes and teams expect after TJS.
Factors Affecting Success Rates
It’s important to recognize the factors that influence a pitcher’s ability to return to peak performance after undergoing Tommy John Surgery. These include the severity of the injury, the athlete’s pre-injury performance level, the quality of the surgical and rehabilitative care they receive, and the athlete’s adherence to their rehabilitation program.
1. Pre-Injury Performance
One key factor is an athlete’s pre-injury performance. The Fury study showed that pitchers who were less successful before surgery—measured by advanced pitching statistics like strikeouts per nine innings (K/9), wins above replacement (WAR), and strikeout percentage (K%)—were less likely to return to the MLB after Tommy John Surgery.
In other words, pitchers who had lower strikeout rates or were less valuable to their teams before surgery had a lower chance of making a full comeback. This suggests that not all athletes are starting from the same place, and those with less impressive pre-surgery stats may have a tougher road ahead.
2. Access to Resources
Another factor to consider is the level of resources available to athletes. The pitchers in Fury’s study are elite professional athletes with access to world-class surgeons, physical therapists, and trainers. They have every possible tool at their disposal to facilitate their recovery. If these athletes struggle to return to peak performance, it raises questions about what outcomes look like for younger athletes in high school and college who don’t have the same level of support.
While young athletes might have greater room for physical improvement compared to seasoned pros, their access to quality rehab and the time they can dedicate to recovery may be limited by factors like school, amateur team support, and finances.
3. Time and Commitment to Rehab
The most important factor affecting the success of Tommy John Surgery is the recovery and rehabilitation process itself. The surgery is just the first step in a long journey back to full health. A typical rehabilitation program lasts 12 to 18 months, during which athletes must undergo extensive physical therapy, strength training, and throwing programs to gradually build up their arm strength and mechanics.
Returning to peak performance requires strict adherence to this rehab program. The time it takes to recover fully depends on various factors, including the athlete’s work ethic, mental resilience, and ability to avoid setbacks like re-injury or overuse during the recovery period.
The Younger Athlete Dilemma
While professional athletes face their own set of challenges with Tommy John Surgery, younger athletes, particularly high school and college players, represent an even more vulnerable population. Over the past two decades, the number of Tommy John surgeries performed on younger athletes has skyrocketed, raising concerns about the long-term impact on their careers.
One of the key reasons for this increase is the year-round baseball culture that has taken hold in the U.S. Young athletes are playing in multiple leagues, attending showcases, and participating in travel teams, often without sufficient rest periods for their arms. This overuse increases the risk of elbow injuries, leading to an uptick in Tommy John surgeries at younger ages.
For younger athletes, the stakes are high. They often believe that surgery will help them return to the field stronger than ever, with many hoping it will give them a better chance at college scholarships or even professional careers. However, the same challenges that affect professional pitchers—long recovery times, the demanding rehab process, and the uncertainty of returning to pre-injury levels—apply to them as well. In fact, younger athletes may face even greater obstacles due to their lack of access to top-tier rehabilitation resources and support systems.
Conclusion: Tommy John Surgery Is Not a Quick Fix
Tommy John Surgery is often viewed as a miracle cure for pitchers, a procedure that will not only restore their health but potentially enhance their performance. But as we’ve seen, the reality is much more nuanced. While the surgery can help athletes return to the field, it is not a guarantee of future success. Only about 57% of MLB pitchers make it back to the big leagues after surgery, and many more never return to their prior level of performance.
For athletes—especially younger ones—considering Tommy John Surgery, it’s critical to understand the commitment required. Recovery is long, challenging, and uncertain. It takes months of hard work, dedication, and patience to regain full strength and ability. Even with the best resources, there are no guarantees.
The road to recovery is just as mental as it is physical. Athletes must be prepared for setbacks and recognize that surgery is only the beginning of a lengthy and difficult journey. In the end, success is not measured by simply returning to the game, but by achieving a true return to peak performance—a feat that is far from guaranteed.
Final Thoughts
If you or someone you know is considering Tommy John Surgery, it’s important to weigh the risks and benefits carefully. Working with experienced medical professionals and following a comprehensive rehabilitation program is essential to maximizing your chances of success. Most importantly, take the time needed to heal properly, both physically and mentally, to ensure the best possible outcome for your athletic future.
Work With Us
At Athletic Potential Performance Physical Therapy, I have had the privilege of helping professional athletes rebuild not only their arms but their entire bodies from the ground up, guiding them through the long and challenging process of returning to peak performance. With a comprehensive, data-driven approach that addresses both the physical and mental aspects of recovery, I can help you navigate the road back after Tommy John Surgery.
Whether you're a young athlete or a seasoned professional, don’t leave your recovery to chance. Work with someone who understands the unique demands of your sport and has a proven track record of helping athletes return to their prior level of performance. Reach out today to schedule a consultation and learn more about how we can work together to rebuild your arm—and your confidence. Let's take the steps necessary to ensure you come back stronger, smarter, and ready to perform at your best.
Your journey to recovery starts now—let’s take it together.
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