It has long been known that the orthopedic elbow surgery procedure known as Tommy John surgery can help restore many baseball pitchers’ speed and accuracy on the mound. But that doesn’t mean the procedure is without a downside or potential for complications: indeed, as with any procedure, it’s not uncommon for a certain percentage of patients to heal without ever regaining the full effectiveness of their youth.

Now a new study has found a clue why this might be: there is a strong correlation between years played and the need for Tommy John surgery, suggesting that wear, and not age, is the primary determining factor:

About 60 percent of the pitchers who required UCL reconstruction had the surgery within their first five years of being in the major leagues. Compared to pitchers who did not have the surgery, those who underwent the procedure had more major league experience at the same age, which suggests that arm stress from earlier major league experience contributed to the elbow damage, the study authors said.

Athletes should read such statistics as a warning about the value of proper care and maintenance, especially if your job entails throwing a ball almost a hundred miles an hour on a daily basis. Good stretching, warmups, warm-downs, and plenty of rest can help mitigate some of the erosive effects of pitching on the ligaments in your arm.

But if the time comes that Tommy John surgery is recommended, be sure and see an expert San Diego orthopedic surgeon. Please contact my offices here to learn more about elbow surgery, recovery, and management.


A counterintuitive thing can happen when people feel overly safe and supported: they tend to take more risks. This phenomenon was detailed wonderfully in Tom Vanderbilt’s excellent book Traffic, among other places. It isn’t hard to understand why: when there’s a big net waiting below, you are far more likely to jump a little farther.

So it is with Tommy John surgery, the wildly popular orthopedic elbow surgery procedure which major league pitchers have been opting for in record numbers. The procedure’s staggering success rate has pushed many pitchers to throw harder at an earlier age, secure in the knowledge that they can hit the “reset” button anytime with a visit to their orthopedic surgeon:

If Tampa Bay Rays left-hander Matt Moore opts for Tommy John elbow surgery as expected, he will be the 13th major league pitcher to have the ligament-replacement operation since spring training. That’s only six fewer than all of last season, and three under the annual average from 2000-2011, according to an industry-commissioned study.

And it’s starting earlier than ever before:

“We mathematically, statistically, scientifically have proven that the kids who play baseball year-round are three times more likely to end up on a surgery table by their 20th birthday that those who don’t,” says Fleisig, citing a 10-year study targeting teenagers who pitch more than 100 innings in a calendar year.

Tommy John surgery is a great advance, and there is no question that it extends careers. But ligaments do not age and strengthen like muscles, and the long-term effects of such optional procedures may yet be unknown in such large numbers. If you have questions about elbow surgery in San Diego, please contact my offices today.


There was a time not too long ago when countless pitching careers were cut short by strain on the elbow ligaments. That was before Dr. Frank Jobe came up with a legendary innovation in orthopedic elbow surgery – a procedure known officially as ulnar collateral ligament reconstruction, and unofficially in clubhouses across the nation as Tommy John surgery.

Deceptively simple in its execution, the procedure, which involves relocation of a forearm tendon to the elbow, has undergone precious few changes since it was first performed on – you guessed it – Tommy John, formerly of the Dodgers. The pitcher’s transformation was swift and decisive.  Today the same technique is prescribed for thousands of athletes, including tennis players and javelin throwers, who undergo extreme  elbow strain on a daily basis.

It’s hard to argue with this watershed in prognosis:

In 1974, Jobe estimated that John’s chance of regaining his form was 1 in 100. Current studies suggest a rate of success, generally defined as an athlete’s reaching the same plane for at least one season, of more than 80 percent.

Dr. Jobe passed away recently, but his legacy lives on in the many active people who appreciate his work every day. As a specialist in orthopedic elbow surgery here in San Diego, I am indebted to Jobe for one of the most effective tools in my arsenal.

© 2023 Dr. Robert Afra – San Diego Orthopedic Surgery Shoulder – Knee – Elbow