Youthful fling with 'Tommy John' surgery

THERE'S good news and bad news about "Tommy John surgery," a technique used to replace a damaged elbow ligament often suffered by athletes, mostly baseball players. The surgery has a high success rate -- 83% -- with most people going back to previous levels of activity, a new study has found. However, more and more young athletes are having the surgery, leaving some experts concerned about the possible ill effects of overtraining.

"This is not a case of inadequate care," says Dr. E. Lyle Cain Jr., fellowship director at the American Sports Medicine Institute in Birmingham, Ala. Cain was lead author of the study released two weeks ago at the annual meeting of the American Orthopaedic Society for Sports Medicine in Orlando, Fla. "I think many young athletes assume that the more they train and participate, the better they'll become. The reality is that the body has to have a certain amount of time off."

Tommy John surgery, or ulnar collateral ligament reconstruction, refers to the replacement of a damaged elbow ligament with a tendon from elsewhere in the body -- usually the forearm, according to Cain. The ligament, he says, provides stability when doing any throwing motion, but can fray, stretch or tear from overuse or without warning from one sudden movement. People with the injury usually experience a sharp pain while throwing, and for baseball players the injury can result in slower pitches and less control of the ball.

During surgery, the replacement ligament is woven through holes drilled in the humerus, a bone that runs from the elbow to the shoulder, and the ulna, a bone in the forearm. Cain says that healing usually takes about three to four months, but that complete recovery takes longer. The procedure was named for former Dodgers pitcher Tommy John, the first pro athlete to have successful surgery. It was performed in 1974 by Dr. Frank Jobe, who pioneered the procedure.

A slew of ballplayers have had the surgery, including Jose Canseco, Mariano Rivera, Josh Johnson and Jon Lieber.

The study tracked 743 people who had the surgery from 1988 to 2006 as patients of Dr. James R. Andrews, senior author of the study and founder of the institute. Their progress was followed for a minimum of two years. The majority (94.5%) were baseball players (high school to major league); the rest were involved in a variety of sports, including track and football. Some 83% were able to return to their previous level of competition or higher.