Dr. ElAttrache asked about baseball’s love affair with velocity leading to spike in elbow injuries.
Published September 25, 2024
Article Link: Tommy John surgery is MLB’s necessary evil 50 years later: ‘We created this mess.’
Today, studies reveal that 36% of all active Major League pitchers have undergone Tommy John surgery, and the rate continues to increase every year. There were more in MLB last year than the entire 1990s.
The biggest problem, renowned surgeons like Dr. Neal ElAttrache, Dr. Keith Meister, Dr. Tim Kremchek and Andrews say, is baseball’s love affair with velocity. High school kids are throwing every pitch as hard as they can to get noticed by the pros and collegiate baseball programs. Professional pitchers are throwing as hard as they can to get paid as much as possible.
And if they break down, they’ll just undergo surgery and take a year off. If they to go under the knife again a few years later, so be it.
ElAttrache completely agrees, believing that MLB needs rule changes to protect pitchers, enabling them to pitch deeper in games. When John returned and won 20 games for the first time in 1977, finishing second in the Cy Young race, there were 907 complete games, 11 by John.
This season, there have been 27 complete games, and no pitcher has more than two.
“The thing I’ve talked to the commissioner’s office about is decreasing the amount of exposure,” ElAttrache says. “If you look at the number of stressful innings and stressful pitches these guys are throwing, I think possibly putting in a seven- or eight-pitch maximum to hitters. So, either you’ve walked, struck out or got a hit by the eighth pitch. If not, you’re automatically out.”
“Now that the tacky substances are eliminated, you’ve got guys that grip the ball with a death grip on every pitch to get the kind of spin they need,” ElAttrache says. “They have to grip the ball in a way that’s very, very hard on the flexor pronator tendons of the elbow.
“Then, at the same time, you put in a pitch clock, so you’ve eliminated the ability to recover in between pitches. You get a guy that is fatigued, and research shows the greatest thing that correlates with injury is fatigue.”
“If it didn’t work the first time, knowing Dr. Jobe like I did, he would have tried it again,” ElAttrache says. “Frank was convinced that this was the main thing that was causing these problems in pitchers’ elbows and was convinced that he had a good way of treating it. He took care of children with polio, and those tendon transfers were a very, very important part of what he did. He saw how tendons could be transplanted and used in different ways, so he was convinced that was a good way to reconstruct that ligament.”
Jobe, who died in 2014 and recognized as one of the most gifted surgeons who graced an operating room, was so confident in his abilities that when he was honored by the Baseball Hall of Fame in 2013, he apologized at dinner to Hall of Famer Sandy Koufax. Koufax, who went 27-9 with a 1.73 ERA in 1966, leading the league with 27 complete games and 323 innings, abruptly retired after 12 seasons because of the constant elbow pain.
He was 30 years old.
“Frank apologized to Sandy, in front of all of us, for not having conceived that operation a few years earlier,” ElAttrache says, “because he said it would have saved Sandy’s career.”
But he was on right on time to save John’s career, and after 288 victories, there’s one common question John is always asked about the surgery.
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