Named for pitcher Tommy John, the first person to undergo the surgery, it was performed for the first time in 1974 by Dr. Frank Jobe, currently listed as an adviser to Dodgers owner Frank McCourt. At that time, Dr. Jobe believed John had a 1 in 100 chance of returning to the big leagues and pitching effectively. John returned to the game in 1976 and pitched for 13 more years until the age of 46.
The central focus of the procedure is the ulnar collateral ligament. In conjunction with the lateral collateral ligament they are the main source of stability for the elbow. They can be torn when there is an injury or dislocation of the elbow. If they do not heal correctly the elbow can be too loose or unstable. The ulnar collateral ligament can also be damaged by overuse and repetitive stress, such as the throwing motion. Bingo, it's an accident waiting to happen for many pitchers.
Stephen Strasburg expected to undergo Tommy John Surgery For Ligament Tear
The damaged ligament is replaced with a tendon taken from somewhere else in the body. The tendon graft can come from the patient's own forearm, hamstring, knee, or foot. It is then woven in a figure-eight pattern through tunnels that have been drilled in the ulna and humerus bone that are part of the elbow joint. Sounds freaky but it isn't. In fact, one source for medical information lists the procedure as taking about one hour to complete. Back in the day, it took Dr. Jobe four hours to wrap up his groundbreaking effort on Tommy John.
The hard part begins after the arm is put in a bulky dressing and a splint for ten days. Full rehabilitation takes one year on average for pitchers. In an interview, Dr. Jobe talked about the minimum time necessary to recover completely. "But I don't think pitchers should come back and pitch off a mound in a game for at least one year, with tossing at four months. You've seen some people that have tried to come back at seven or eight months. They got sore and inflamed, then you have to wait a couple of months before that goes away."
As for effectiveness after the rehab is complete, Dr. Jobe says that the surgery by itself doesn't increase a pitcher's velocity. He has seen the ligaments deteriorating for a while prior to the actual ligament tear. In no case can it make a pitcher better. As Jobe says, "All the surgery does is get you back to your normal elbow. You either have the stuff or you don't."