What’s ahead for Andrew Painter with Tommy John surgery
Hundreds of major leaguers have had Tommy John surgery since surgeon Frank Jobe first performed it in 1974.
Phillies pitching prospect Andrew Painter had his elbow joint rebuilt on Tuesday, becoming the latest of many major leaguers to undergo the procedure nicknamed Tommy John surgery.
The surgery was developed in 1974 by surgeon Frank Jobe, named after his first patient, Dodgers pitcher Tommy John, who went on to pitch 14 more seasons.
Hundreds of Major League players have undergone the surgery since then, most of them recovering to near their pre-injury ability level.
But full recovery is not a given. Patients must carefully follow the prescribed regimen of rehab exercises — and even then, some pitchers do not return to full strength until two years after the surgery.
Painter, 20, is unlikely to pitch in the majors until the 2025 season.
For more on how surgeons rebuild the elbow joint, why the procedure is so common, and whether there’s any truth to the belief it can make pitchers throw even faster, we spoke to orthopedic surgeon Patrick M. Kane at the Philadelphia Hand to Shoulder Center.
Which Phillies have had Tommy John surgery?
Phillies pitchers who have undergone Tommy John surgery include Seranthony Dominguez and Zack Wheeler, who had the procedure in 2015 when he was with the New York Mets.
The surgery isn’t just for pitchers. Bryce Harper got the surgery in November 2022 after his World Series heroics. He injured the elbow while playing right field, then served as a designated hitter before going under the knife. He returned to action just 160 days after the surgery, faster than anyone else in the majors.
What is Tommy John surgery?
The surgery is performed when players injure their ulnar collateral ligament, an inch-long piece of tissue connecting the ulna (a bone in the forearm) with the bone in the upper arm.
Sometimes surgeons opt simply to repair the ligament, supplementing it with an internal brace, Kane said.
Tommy John surgery, on the other hand, refers to a full reconstruction performed when the joint has undergone significant stretching or tearing.
How is Tommy John surgery done?
To rebuild the elbow joint, surgeons take a nonessential tendon from elsewhere in the person’s body, usually the forearm or the hamstring.
The surgeon uses a portion of this tendon to weave the two elbow bones together. The surgeon drills holes in each of the bones, then threads the tendon through them, almost like shoelaces.
But unlike with shoelaces, one end of the tendon is sutured to the other, resulting in a closed loop in the shape of a figure eight. In some cases, surgeons also secure the loop to the bones with anchors, Kane said.
Why do so many pitchers need Tommy John surgery?
Throwing a baseball at high speed places tremendous strain on the arm, especially for those who do it 90 or 100 times a game and repeatedly — on more than 30 occasions each season.
The ulnar collateral ligament, located on the inside of the elbow, bears an especially high strain, as the pitcher cocks it sideways before snapping the arm forward.
Orthopedic surgeon Kenneth A. Kearns, a colleague of Kane’s, describes the motion as like suddenly “revving your car’s engine up to 9,000 RPMs.”
How long does it take to recover?
After the surgery, patients start with exercises to regain their range of motion. Later, they add additional moves to build up strength.
For pitchers, it often takes 12 to 18 months to recover to the point that they can pitch without fear of reinjury. But they may not regain full strength for up to two years.
Position players like Harper typically return to action sooner, though his speedy, 160-day return was unprecedented.
How many pitchers make it back to form?
Roughly 70% to 80% of pitchers get back to near their preinjury form after Tommy John surgery.
On average, pitchers who return to action throw a bit slower than they did before injury, but this falloff is not significantly different from normal age-related decline, according to one Columbia University study.
Some athletes need a follow-up “revision” surgery. In such cases, the player is less likely to return to action afterward.
Can the surgery make pitchers even faster?
It’s a common belief that Tommy John surgery enables pitchers to throw even faster.
Not true, Kane said.
Yes, the procedure can help pitchers throw faster than they did while injured, especially if they do the right exercises to build up strength. But the reconstructed joint does not enable them to throw any faster than their “natural” preinjury peak speed, he said.
“It’s not like you’re putting in something better than what was originally there,” he said.