The American Sports Medicine Institute Position Paper on Tommy John Surgery Epidemic

Matt Moore after his Tommy John surgery in late April - Kim Klement-USA TODAY Sports

Ulnar collateral ligaments are tearing at an unprecedented rate. Dr. James Andrews and the ASMI weighs in.

When it comes to Tommy John surgeries the Phillies have actually been fairly fortunate. They reported only one TJS in the 2013 calendar year (Andrew Knapp), and two in 2012 (David Herndon and Jose Contreras), though they have had their share of pitchers dealing with shoulder injuries. Regardless of the Phillies situation, professional baseball does seem to be witnessing something of an epidemic of torn ulnar collateral ligaments.

That's one out of every five pitchers to throw a regular-season pitch, and that tweet is a month old. In the intervening time we've seen more players go under the knife, including Matt Moore, Jose Fernandez, Josh Johnson, and Ivan Nova.

The afore-linked Joe Rogele of The Hardball Times and TGP sister site Beyond the Box Score maintains a list of all MLB/MiLB players known to have undergone Tommy John surgery. It’s a somber spreadsheet, as every name on it represents the loss of production and money, and a career forever altered. This year it only seems to be getting worse. As Rogele notes:

Yesterday the American Sports Medicine Institute (ASMI), led by preeminent orthopedic surgeon Dr. James Andrews, weighed in on the epidemic with a position statement cataloging the problem, listing common misconceptions about Tommy John surgery, and providing some advice on how UCL injuries may be avoided.It's short and easily accessible to the lay audience, so I suggest you check it out if you're interested.

A few main points:

  • One common misconception listed, and I've seen pop up way too often, is as the position paper puts it, "pitchers should get Tommy John surgery over with as soon as possible, as they will be better and throw harder after the surgery," and variations on that theme. No. If a surgery can be avoided, it is to be avoided. As Kyle Boddy of Driveline Baseball (who, incidentally, has worked with former Phillies draftee Ben Wetzler) points out:
  • Pitchers who throw at a high velocity are at elevated risk for TJS. This is problematic because velocity is everything.
  • Be cautious of pitching in winter ball. Rest is integral to UCL health, and efforts must be made to ensure players have enough downtime to recover.
  • Utilize optimal pitching mechanics. Unfortunately, as of last year only two teams in baseball have each of their pitchers undergo a complete biomechanical analysis, Baltimore and Milwaukee.
  • Open communication between player, management, and training staff! It is extremely important that the training staff be appraised of how the pitcher feels and of any changes in arm health, so care can be personalized to the pitcher in accordance with the health of their arm.
  • ASMI suggests that pitchers should not always pitch at 100% effort. That's an interesting suggestion, and I'm not sure how that's going to apply to high-leverage bullpen arms who, it seems, are frequently put into positions where strikeouts are very important, and are often touted for their high velocities. Jeff Passan also points out a potential problem here:

These are interesting and common sense suggestions, but like all advances away from tradition there will always be clubs that are slow to adopt some or all them. That 28 out of the 30 clubs do not undertake a complete biomechanical analysis of their all of their pitchers, which would cost little in the scope of running a professional baseball organization, is sadly telling.

Andrews also offered advice for the adolescent pitcher in a previous position statement and has publicly talked about those positions in the past.

It's a tragedy any time a pitcher is forced to miss 12-18 months of their pitching career to Tommy John surgery, regardless of their age or level of play, and so using all information at our disposal to figure out how to best prevent said injuries should be the goal of every baseball team, from little leagues to the majors. Check out the ASMI paper here.

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