UTK Special 5/21/20

Tommy vs. Seth

I’m including a surgical video in this article. If you’re squeamish, don't click through.

Tommy John often says that he wishes the surgery had a different name. Frank Jobe told me that if he’d just thought of it earlier, it would have been called Sandy Koufax surgery, though think about how odd that sounds now.

Side note: I’ve never been able to fact check this. Jobe mentioned in our extensive interview that I did ahead of this article that Koufax had Tommy John surgery, but much later in his life. I think he said that Koufax had come to him after playing golf, but I can’t find that. If anyone out there has access to Koufax, I’d love to know if that’s true.

The fact is that Tommy John is now the accepted name. People often think it’s a different surgery than elbow reconstruction surgery because the name is just so known and common. It’s the Kleenex of orthopedics. The reason is not that it’s a simpler, shorter thing; it’s because it worked.

Tommy John had an almost perfectly bifurcated career. He won 164 games after the surgery and 144 before (with almost 200 no decisions.) He pitched for the Dodgers and Yankees, winning World Series' with both. He won 20 games in back to back seasons.

In other words, he was successful.

Brent Strom is a great pitching coach. As a pitcher, well, let’s just say he wasn’t Tommy John. He was the second pitcher and third athlete overall to have the surgery*, but what if he’d been the first?

That, I think, is the problem with a new variant of the surgery. That surgery, alternately called “primary repair” and InternalBrace (which is Arthrex’s official name for the technique), was first done on a professional pitcher who wasn’t successful, before or after.

Seth Maness is 18-10 over his career, which includes two Major League stops since the surgery. He didn’t come back faster, but there’s no clear evidence that it was because the surgery/rehab was the issue. It was his effectiveness. He simply couldn’t crack the rotation, though there’s some question about when exactly he would have been ready.

The surgery itself and variants of it, like it’s use in thumb and knee surgery, have been very successful. Mike Trout missed just over a month after having his thumb fixed with InternalBrace, while his teammate Andrelton Simmons missed just less. There’s a theoretical low end on that recovery of about two weeks, though no one at the professional level has tested it. Even at the four week mark, the surgery saved six weeks of Mike Trout, which alone makes it worthwhile.

There’s only a handful of surgeons that do this, most notably Jeff Dugas out of Birmingham. One of the top surgeons at James Andrews’ facility (and a burgeoning booze maker if someone would like to send me a bottle), Dugas has done what he’s described as “several” of these elbow operations on high school and college pitchers. Due to privacy regulations, Dugas (and others) have not been able to show just how successful or even do more than hint at how quickly players can come back.

InternalBrace is what was used on both of Tua Tagovailoa’s high ankle injuries, with both repaired using what is called a Tightrope technique. Tagovailoa came back from both surgeries to play at Alabama again before his hip fracture ended his collegiate career. When I spoke with doctors who saw him at the NFL Combine earlier this year, none were concerned with the repair of his ankles, though some expressed concern about what having both done said about his overall ligament strength.

One doctor told me he was able to get a college football player back from an ACL sprain in a matter of weeks. Again, details were fuzzy, but I believe he was saying that the player came back to a high level program in less than three months, which would be a huge gain. While unconfirmed, this does match up with the data we do have about what is theoretically possible.

The reason is that most reconstructive surgeries require full healing before the joint can be loaded. This results in a major drop in workload (plus muscle atrophy) and requires a wait for the healing to take place, mostly in the bone where the new ligament is anchored. With InternalBrace, there’s a minimal period needed and there’s the equivalent of a seat belt over the repaired ligament. It’s at full strength from day one.

“When you nail in a board, you don’t wait for the wood to set,” said one doctor who regularly operates on MLB and NFL players. “The [material] that overlays is strong, so in theory, you could walk right out and play. That’s not practical, we know, but we’re probably not even close to testing the short end of the necessary rehab with any joint.”

Since Maness’ surgery in 2017, there’s no known MLB pitcher who has had the technique. I have suspicions about one, but have never been able to get confirmation. Part of the issue is that surgeons are very picky about who they choose to do this surgery on. The bigger part, I believe, is that players and agents don’t seek it out. That is largely because we haven’t had a success.

It’s a chicken-and-egg issue. No one’s asking for Seth Maness surgery, but until someone comes back both quickly and successfully, no one is going to.

My guess (and hope) is that we see one of these 100 mph plus guys, who break at a higher rate than most, has the surgery and comes back in season. It will take an early spring injury, but we know those happen. Even if they only pitch on a limited basis - imagine getting Noah Syndergaard or Chris Sale back for a playoff run - that surgery instantly becomes an option. Imagine a Jordan Hicks - who had his surgery in late June - coming back in three months for a late season boost to the Cardinals playoff hopes in 2019. It’s possible, if not probable.

We’re left with a technique that works, but no one that wants it. It’s a demand issue. It’s asking for a change from a very successful, very well-known surgery in a sport that loathes change. The issue really becomes one of time. Which team or player/agennt will figure out that getting back faster is more valuable than the common? Which player wants his name on a surgery?

*That second person is lost to history. Jobe remembered it was a Russian javelin thrower. It would have been at least a year after John’s surgery. You have to think it would have to have been an elite thrower to have Russia in the mid-70s send someone over to Los Angeles for an experimental surgery. I’ve never been able to figure out who it was.