Saving Pitchers’ Careers: The Story and Science of Tommy John Surgery
- Ruhan Patel
- 3 days ago
- 6 min read
It has been a while since my last post, but I’m excited to be back and writing again. Today I'm diving into one of the biggest advancements in sports medicine history: Tommy John surgery. If you’ve spent any time around baseball, you’ve heard this name before, and with more pitchers than ever tearing their UCL and facing year-long recoveries, this procedure has become almost as common in baseball as the fastball itself. In this article, I’ll break down what the surgery is, why it’s happening so often, and what it means for athletes at every level.
The story of Tommy John surgery starts in 1974, when Los Angeles Dodgers pitcher Tommy John faced what was then considered a career-ending elbow injury. Team physician Dr. Frank Jobe performed the first-ever ulnar collateral ligament reconstruction, taking a tendon from John’s forearm and using it to replace the damaged UCL in his pitching elbow. At the time, Jobe estimated the odds of a successful comeback at only about 1 in 100, but Tommy John went on to pitch 14 more seasons and win 164 additional games, turning the experiment into a revolution in sports medicine (ESPN).
Now let's look into the injury itself. Because the name “Tommy John surgery” is more well-known than the injury behind it, many people don’t even realize what’s actually being repaired. Tommy John surgery fixes a torn UCL, which stands for the ulnar collateral ligament. The elbow joint is stabilized by three main ligaments, the UCL, the RCL, and the annular ligament, but the UCL is the one that takes the most stress during throwing. To put it simply, you use this ligament anytime you raise your arm above your head and throw something. The UCL connects the humerus to the ulna along the inner side of the elbow and helps resist the strong forces created when an athlete accelerates their arm forward. This ligament plays an essential role in stabilizing the elbow, especially for pitchers and other overhead athletes who repeatedly place high loads on it.
What actually causes the UCL to tear? As mentioned earlier, the UCL is heavily used during any overhead throwing motion. Each pitch places intense stress on the inside of the elbow, and over time these forces begin to wear down the ligament. The UCL acts almost like a thick rope on the inside of the elbow, keeping the joint from opening under the massive force of each throw. When that “rope” is repeatedly stretched, frayed, or overloaded, especially at high velocities, it can eventually weaken or tear. This is why pitchers, who may throw hundreds of high-intensity pitches every week, are the athletes most likely to suffer UCL injuries. MCL tears are classified into three grades: Grade 1 involves a stretched ligament, Grade 2 includes a stretch with a partial tear, and Grade 3 is a complete tear (Cleveland Clinic).
We now understand what a UCL tear actually is, so let’s talk about the surgery. There are actually two main surgical options to repair a torn UCL. The first is the classic Tommy John surgery, where the damaged ligament is replaced with a healthy tendon taken from elsewhere in the body. The second option, UCL direct repair, involves reattaching the existing ligament back to the bone, which is usually reserved for younger athletes with cleaner, more localized tears (Cleveland Clinic).
For Grade 1 and some Grade 2 injuries, athletes can sometimes avoid surgery entirely, since the ligament is only stretched or partially torn and may heal with rest and structured rehab. But when the tear is more severe, or when players feel pressure to return faster, surgery becomes the more reliable path back to competition. After all, who wouldn’t want to get back to throwing fastballs? However, rushing the process or returning too early can be detrimental and puts athletes at serious risk for re-injury. This is where the importance of a well-planned, structured rehabilitation program becomes essential
Proper recovery from a UCL injury takes time and patience. Non-surgical cases can take anywhere from a few weeks to several months depending on the severity of the tear and how well the ligament responds to rest, bracing, and targeted therapy. For athletes who undergo Tommy John surgery, the full return-to-play timeline is typically around 12 months, since the new tendon needs time to heal and gradually regain strength. Rushing the process can greatly increase the risk of setbacks or even a re-tear, which is why following each phase of rehab is essential for a safe return to throwing.
Even with a clear recovery timeline, some athletes still push the limits, and Noah Syndergaard is a perfect example of how dangerous that can be. Syndergaard was drafted out of high school by the Toronto Blue Jays with the 38th overall pick in 2010 as a teenager with huge potential. He quickly became one of baseball’s most promising young arms, and in 2016 he enjoyed his best season: a 14-9 record with a 2.60 ERA, 218 strikeouts over 183⅔ innings, earning an All-Star selection and finishing eighth in the NL Cy Young voting (ESPN). Unfortunately he dealt with injuries through his career, and in 2020 underwent Tommy John surgery to repair his torn UCL. When he attempted his comeback, he rushed into action, experienced setbacks in his throwing, and his performance never returned to his peak form (MLB).
Syndergaard’s story is tough to watch because he had all the tools to become one of the dominant pitchers of his generation, yet injuries and an accelerated return robbed him of the chance to fully realize that potential. But his journey also serves as an important lesson for athletes at every level: no matter how talented you are or how badly you want to get back on the field, taking injuries seriously and respecting the recovery process is crucial. Pushing too hard, too soon can cost far more than patience ever will.
But while Syndergaard’s story is a reminder of the risks of rushing the process, there are also countless success stories that show just how much hope there is for athletes recovering from UCL injuries. Tommy John surgery has saved and extended the careers of some of the biggest names in baseball, stars like John Smoltz, Walker Buehler, Stephen Strasburg, Nathan Eovaldi, and many others who returned to high-level performance after a full, disciplined rehab. And perhaps the best example of all is Shohei Ohtani. After undergoing Tommy John surgery in 2018, he committed to a long, structured rehabilitation and not only returned to the mound but reclaimed his place as one of the most elite players in the world. His comeback season showcased his dominant pitching, explosive velocity, and two-way superstar abilities, proving just how effective proper recovery can be. Ohtani’s success story shows that with patience, discipline, and the right approach, athletes can come back stronger, and sometimes even better than before.
Since the first ever surgery on Tommy John himself, the technique has been refined over decades. Early versions of the procedure had uncertain outcomes, but modern UCL reconstruction now boasts return-to-play rates in the 80–95% range for many throwing athletes, with long-term studies showing that the majority are able to get back to their previous level of performance. Newer variations, like hybrid fixation methods and internal brace augmentations, are designed to improve graft stability and, in some cases, shorten recovery time without sacrificing elbow durability (PubMed).
For the baseball players reading this, there are several key steps you can take to protect your elbow and reduce the risk of a UCL injury. Proper conditioning and strengthening of the muscles around the shoulder and elbow help support the joint, while good throwing mechanics ensure the elbow is not taking on unnecessary stress. Just as important is listening to your body; resting whenever you feel discomfort can prevent a minor irritation from turning into something far more serious. For pitchers, following pitch count limits and mandatory rest days is crucial, since these guidelines are designed specifically to keep the elbow from being overloaded. Taking these precautions seriously can make a huge difference in keeping you healthy and on the field.
There you have it, Tommy John surgery has become one of the most important procedures in modern baseball, not just because of how common UCL injuries are, but because of how life-changing proper recovery can be. Stories like Noah Syndergaard’s highlight how dangerous it can be to rush the process, while Shohei Ohtani and many others prove that with patience, discipline, and the right rehab plan, athletes can return to elite form. At the end of the day, protecting the elbow starts long before an injury happens. By training smart, listening to your body, respecting pitch limits, and giving yourself the time you need to heal, players at every level can keep themselves healthy and on the field for years to come.
