Wednesday, April 13, 2011

Tommy John Surgery - Not the Savior Some Think

Study finds statistical dips following the procedure

A study conducted by St. Vincents and Richmond Orthopedics has recently found out that Major League pitchers see a significant decrease in performance after they have Tommy John surgery. Compared to pre-operation performances, Major League pitchers had a significantly higher earned run average and significantly lower strikeouts per nine innings after receiving Tommy John surgery.

Eugene Shkolyar, one of the main researchers who worked on the project, said that the results of the study backed up his initial hypothesis, but went against what many consider to be the public perception of the surgery.

“A lot of people believe that a pitcher actually will improve after having Tommy John surgery,” he said. “Ask a typical baseball fan and they will think the pitcher will come back from it in top form, perhaps even better. This just isn’t true; as the results from our study shows, Tommy John surgery significantly hurts pitching performance in the Major Leagues.”

Pitch, Pitch, Pop

Tommy John surgery, officially known by doctors as Ulnar Collateral Ligament reconstruction, has become more and more prevalent in baseball at all levels in the past two decades. The surgery is usually required after pitcher’s arm wears down from overuse. Dr. Frank Jobe, who first performed the procedure in 1974 on pitcher Tommy John, for who the procedure is now named, told Sports Illustrated that the nature of the injury comes from the repeated wear and tear that a pitcher puts on his arm.

“"Even if the ligament just ruptures at once, the very nature of pitching is that you wear down," said Jobe.

While you may hear a pop or feel a strain after one particular pitch, it is all of the pitches leading up to that that contributes to the injury.

Tommy John surgery is a procedure in which a ligament in the injured elbow is replaced with a tendon from somewhere else in the body. Often times this tendon comes from the forearm, hamstring, knee, or foot.

Arm troubles widespread

The study analyzed 33 Major League baseball pitchers who had Tommy John surgery from 1987 to 2004. The researchers looked at stats such as earned run average, walk plus hits per inning, and strikeouts per nine innings, before and after the surgery. It was a retrospective case study. They compared the stats to the Major League averages in ERA, WHIP and K/9; this was the control group.

According to the research report, 87% of Major League Baseball pitchers had some sort of collateral ligament abnormality in their dominant elbow. In addition, it has been shown that 8 out of 11 pitchers with no symptoms had MRI changes consistent with increased damage to the UCL in the form of micro tears. A frequency of 4 in 14 youth baseball pitchers with no symptoms displayed increased thickness of the ulnar collateral ligament on MRI.

“Tommy John surgery has become routine in baseball circles in recent years,” said Shkolyar. “The repeated use of the arm by pitchers is going to wear it down, and pitchers see this surgery as the most effective way to fix it.”

The rehabilitation time for Tommy John surgery patients typically takes between 12 and 18 months. Players can typically regain the full strength of their arm and physically they perform at about the same level. Recent studies cited in the report indicate that between 74% and 98% of pitchers who had the surgery were able to come back and play. According to the research report, however, the goals of the surgery are not to assure players get back to their original statistical plateau.

“The goals of UCL reconstruction in MLB pitchers are, however, the restoration of pre-injury pitching ability, pain relief, and restoration of elbow stability and not simply a return to a similar level of performance,” the report read.

The study, according to Shkolyar, aimed to find out how efficient the surgery was when it came to statistics, rather than when it comes to restoring pitching ability.
The statistics that they found concluded that pitchers have a worse statistical performance after undergoing ulner collateral ligament reconstruction than they do before having the surgery.

Same pitcher, different results

Earned run average is one of the main statistics used to measure the performance of pitchers in Major League Baseball. Prior to having Tommy John surgery, the mean earned run average was 3.88, while after having the operation the mean ERA skyrocketed to 4.49. This compares to the control group mean ERA of 4.29.
Strikeouts per nine innings also had a significant change after Tommy John surgery. Prior to the procedure, pitchers had a mean K/9 of 8.19. After the surgery, this mean dropped to 6.50. The Major League average was 6.29.
Walks plus hits per inning results lowered as well after the surgery, going from 1.32 pre-op to 1.41 post-op. However, this dip was not considered statistically significant by the researchers as the control mean was 1.39.

“We found that in 2 of the 3 categories, pitchers statistics significantly decreased following Tommy John surgery,” said Shkolyar. “While they may have returned to original physical ability, the surgery did have a negative effect on their statistics.”

Players are for it

Mainstream media sometimes perceives the surgery as being a savior for pitchers, however, leading some to think their performance will increase. A 2003 USA Today article proclaims that Tommy John surgery is “A pitchers best friend.” Testimonials within the story from pitchers tend to back up that assertion.

“I hit my top speed (in pitch velocity) after the surgery”, says Wood, the former Cubs All-Star to USA Today in 2003. “I'm throwing harder, consistently."

Other Major League pitchers who talked to USA Today agreed.

"Tip your hat to modern medicine," said former pitcher Pat Hentgen, after his first full season back from the surgery. "As far as the way my arm feels, it feels like it never happened."

Despite these ringing endorsements from players, the numbers speak for themselves. Pitchers stats are proven to take a dip after Tommy John surgery.

“It would have been worse for the pitchers if they had these injuries 20 years ago,” said Shkolyar. “Their careers could have been done. The surgery gives them a chance to regain their old form, but as the study shows the chances are they will not have improved stats.