Elbow scars bind 51s’ staff

In 1974, the same year "The Six Million Dollar Man" went on the air, major league pitcher Tommy John underwent the elbow ligament replacement surgery that’s named for him.

Nearly 40 years later, the revolutionary procedure has helped extend the careers of countless pitchers: from John himself to Cy Young Award winners John Smoltz and Chris Carpenter to current All-Star sensation Stephen Strasburg.

But with the success rate for pitchers regaining their pre-Tommy John form estimated at 80 to 90 percent, it’s often assumed that the surgery alone can virtually guarantee that a pitcher will be able to throw harder than before, with a veritable bionic arm.

Several 51s pitchers who have had the procedure say that’s not the case; the key to a successful comeback is rigorous rehabilitation.

"It’s the rehab program. That’s the magic, not the surgery," said right-hander Shawn Hill, who has had two Tommy Johns, in 2004 and 2009. "There’s magic in (the surgery), if that’s what you want to call it, but that’s not why guys come back stronger.

"It’s because before the surgery, most guys aren’t doing a shoulder program every day, or forearm exercises and all that stuff. When you come back, generally you’re stronger and more fit. That’s why they throw harder."

In a disturbing trend, some overeager parents have even asked surgeons to perform a Tommy John on their sons’ healthy arms, hoping to get the seemingly inevitable procedure out of the way as early as possible.

51s reliever Clint Everts witnessed this firsthand in 2004, when his surgery was performed by Dr. James Andrews, one of the country’s foremost Tommy John specialists.

"There were kids in (his practice) with their parents asking for them to have a Tommy John, because everybody thought if you had a Tommy John you’re automatically going to throw harder," he said. "That was a real big misconception. You don’t ever want to have surgery."

After his surgery, Everts, the fifth overall draft pick by the Montreal Expos in 2002, said it took five years until he felt like himself again.

Although he’s enjoying a strong season for the 51s, the 27-year-old never regained his pre-surgery velocity and doesn’t buy into the belief that most pitchers return to top form after a Tommy John.

"Personally, I feel like for every guy that comes back throwing harder, there’s 10 guys that don’t come back at all or really struggle to get back to where they were," he said.

The procedure, developed by Dr. Frank Jobe, is an ulnar collateral ligament reconstruction in which the ligament in the elbow is replaced with a tendon from elsewhere in the body – often a forearm, hamstring or foot.

The new tendon is implanted and woven in a figure-eight pattern through holes drilled in the humerus and ulna bones.

After performing the surgery on John, Jobe put the pitcher’s odds of returning at one in 100. John, who had 124 wins in 12 seasons prior to the procedure, spent 18 months rehabbing his arm before returning to win 164 games over his final 14 seasons. He retired in 1989 at age 46.

Of more than 200 pitchers who’ve had the surgery, there are plenty of success stories. This season alone, Philip Humber threw a perfect game for the White Sox, Giants starter Ryan Vogelsong has one of baseball’s lowest ERAs (2.31), and Edinson Volquez fired a one-hit shutout Thursday for the Padres.

Players who failed to regain their form include Toronto’s former All-Star closer B.J. Ryan and former Cy Young Award winner Pat Hentgen, as well as former Rangers All-Star Jeff Zimmerman.

The 51s’ Hill, 31, is one of more than 20 pitchers who’ve had two Tommy Johns, a list that has grown this season to include Giants closer Brian Wilson, Royals closer Joakim Soria and Blue Jays starter Kyle Drabek.

The success rate for players with multiple surgeries drops to about 25 percent – odds Hill managed to beat in 2010, when he returned to the majors with Toronto less than two years after his second procedure.

One of five pitchers on the 51s who have had the surgery – along with Everts, Jerry Gil, Jim Hoey and Nate Robertson – Hill said players no longer dread the procedure.

"The big thing is now it’s not as scary as it was 20 years ago," Hill said. "It’s still a major surgery and the outcome is not certain, but the odds are in your favor now whereas before they weren’t.

"I don’t think guys freak out quite as much as they used to when they find out they have to have it."

Gil, a right-handed reliever, is a rarity in that he converted from position player to pitcher after his 2007 Tommy John.

"I think I’m the first one," he said.

The power-hitting shortstop-turned-power pitcher is throwing harder than ever, hitting 98 mph on the radar gun Thursday at Cashman Field.

"If you work the way you’re supposed to in the rehab program, you’ll probably come back as strong," Gil said. "Or even better."

Contact reporter Todd Dewey at tdewey@reviewjournal.com or 702-383-0354.