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Ulnar Collateral Ligament Reconstruction In Baseball Pitchers
Chapter 1-Introduction

The Invention: Dr. Jobe and Tommy John
 
     Major league baseball player Tommy John once noted, "When I dont think I can play anymore, I'll quit.  I just havent found a summer job that pays as well."  In 1974, however, he almost did have to quit when he tore the ulnar collateral ligament in his left elbow while pitching.  Tommy was not willing to accept that he had a career-ending injury.  When the 31-year-old, left-handed pitcher was evaluated by the Los Angeles Dodgers team physician, Dr. Frank Jobe, he told the orthopedic surgeon to make up something that would fix his arm. 
    
      Dr. Jobe knew of cases where polio patients had undergone ligament replacement or tendon transfers and theorized that it would be possible to do the same with Tommy John's ulnar collateral ligament (Greenfield and Rogers 2000).  Polio is a disease caused by a viral infection that affects motor neurons.  It often causes muscle weakness, and in order to combat this problem, surgical techniques were invented to strengthen affected areas.  The tendon transfers involve detaching the tendon connected to a functioning muscle and transferring it to a debilitated muscle to help redirect the power the tendon exerts (Beasley 1970).  These were normally performed in polio patients where there was irreparable nerve or muscle damage.  Jobe saw the possibility of using the knowledge gained from these tendon transfer operations and applying it to John's injury.
     
     The surgery was risky.  Although Dr. Jobe told John that his options were "to do nothing and never pitch again or try an untested surgery and still never pitch again" (Greenfield and Rogers 2000), Tommy was not ready to give up.  Dr. Jobe has stated that John encouraged him to go ahead with the surgery regardless of the dangers involved.  Dr. Jobe replaced John's torn ulnar collateral ligament with the palmaris longus tendon from his right forearm.  Holes were drilled in the bones above and below the elbow, and the tendon was threaded through.  Three months later another surgery was needed due to complications involving John's ulnar nerve.  The nerve was transposed in this hazardous surgery, and Jobe told John he would likely never pitch again.  John was determined, however, and he slowly worked his way back.  It took hours of playing catch with his wife to work his strength back up to where it needed to be.
    
     After eighteen months of rehabilitation, Tommy John was playing for the Los Angeles Dodgers during spring training, 1976.  That year John pitched in thirty-one games, including eleven complete games.  He pitched two hundred and seven innings, giving up seventy-one earned runs for an earned run average of 3.09.  He had 91 strikeouts and allowed only 61 walks on his way to a ten-win and ten-loss season.  He was picked as "Comeback Player of the Year," and the next year he won twenty games and finished second in Cy Young voting.  In the fourteen seasons following his surgery, Tommy John won a total of one hundred and sixty-four games, tallying ninety-one complete games along with way.  Pete Rose once commented on Tommys success, "I know they had to graft a new arm on John, but did they have to give him [that of] Sandy Koufax?" (Greenfield and Rogers 2000).
    
     John could not have been happier with his results.  He once bragged, "The most successful surgery that was done was mine.  When I came back I didnt miss a game due to soreness.  I missed games, but it was because of the flu or because I was sick but never because of my elbow "(Greenfield and Rogers 2000).  The risk that Dr. Frank Jobe and Tommy John took in 1974 has changed the game of baseball.  What was once considered a career-ending injury is now seen as a twenty-five thousand dollar (Siegel 2000) problem that will only set the pitcher or position player back a year.