Teen athletes seek an edge through early "Tommy John" elbow surgery
Teen athletes who overtax their throwing arms are increasingly turning to surgery to get back in the game.
Male teens between ages 15 and 19 now account for the majority of "Tommy John" surgeries to reconstruct elbow ligaments, usually a result of a common sports injury from overusing the throwing arm, according to a new study published in the American Journal of Sports Medicine. And the number of procedures is growing fast.
"It's not a benign procedure," the study's lead author, Dr. Brandon Erickson of Rush University Medical Center in Chicago, told CBS News. "This is not something that should be done unless there's injury to the crown ligament and this is a patient who wants to continue to pitch at a high level."
After noting a rise in young patients in their own practices, Erickson and the team of researchers were looking for more information about exactly who is having the Tommy John surgery, or ulnar collateral ligament reconstruction (UCLR).
Researchers analyzed a large database of patients who used private insurance that billed for the specific code for UCLR between 2007 and 2011, a total of 790 patients. Teens 15 to 19 years old accounted for almost 57 percent, the majority of these surgeries. The surgery rate for that age group has been increasing by about 9 percent per year, they found.
The next closest age group, 20- to 24-year-olds, accounted for 22 percent of the operations.
For many young athletes, the surgery gives them a chance to continue playing competitively. "It's a surgery that has good results in that 80 to 90 percent get back to the level they were playing before, but that's not 100 percent," said Erickson. "They may get back to the same level, they may not get back to the same level. They may lose a little speed off their fastball, they may lose a little accuracy. They may have some pain in their elbow."
More serious risks could involve a long-term change in feeling and function for their elbows or hands.
"With this specific surgery there's a risk of injury to a nerve that runs right around the elbow, it's called the ulnar nerve. It gives a lot of function to your hand," said Erickson. "If you have an injury to that nerve, you can wind up with significant dysfunction afterwards."
UCLR is often recommended for highly competitive athletes who want to resume their careers, and many Major League Baseball pitchers have had it. The surgery involves a transplant of tendon, either from other parts of the patient's body or from a deceased donor. "Tunnels" are drilled in to the connecting arm bones and the replacement tendon is threaded through them and wrapped several times for strength. The common procedure is usually performed on an outpatient basis or in clinics.
Tommy John surgery was named after the pitcher and first professional athlete to have it in 1974. It is most often seen in baseball pitchers and sometimes basketball players -- athletes who perform repetitive, overhead throwing motions. Without surgery, pain management using standard techniques like ice and painkillers is the only treatment. The injury used to be known as a career-ender until the procedure was invented.
It can take up to two years to fully recover from the surgery, so the earlier an athlete has the surgery, the more years of their playing career remain afterwards. Though a majority of patients will recover their full capabilities, there are many who will never reach their pre-surgery potential again.
"The research numbers suggest that more young athletes believe that having an UCLR procedure performed earlier in their career may lead to the big leagues or a scholarship, even though only one in 200 kids who play high school baseball will make it to the MLB," said Erickson.
Some could be using it too soon, as a means to prevent less severe elbow injuries from progressing. A previous study found 51 percent of high school athletes and about a third of coaches and parents believed the surgery could be performed on healthy patients to enhance their performance.
The researchers also found that southern states had higher rates of the UCLR surgery, accounting for 53 percent of the patients in this survey. Erickson says this could validate research that points to players in warmer climates who pitch year-round having more of the surgeries. There are also more doctors in the region who specialize in the UCLR.
Most of the surgeries were performed between April and June, suggesting that injuries happen earlier in the season.
"We need to find a better way to prevent these injuries in these athletes. Unfortunately, it's definitely becoming a problem," said Erickson.