Feb 25, 2014; Surprise, AZ, USA; Kansas City Royals relief pitcher Luke Hochevar (44) throws during a workout at Surprise Stadium practice area Mandatory Credit: Joe Camporeale-USA TODAY Sports

A Look at the Increase in Tommy John Surgery


Mar 8, 2014; Phoenix, AZ, USA; Kansas City Royals starting pitcher John Lamb (38) throws against the Milwaukee Brewers in the first inning at Maryvale Baseball Park. Mandatory Credit: Rick Scuteri-USA TODAY Sports

It has seemingly gotten to the point where Tommy John surgery has become part of the norm in baseball. With just over a week and a half left in Spring Training, there have already been seven players who either have, or will shortly, undergone that procedure. The Kansas City Royals are certainly no strangers to having pitchers need to have the surgery performed, losing Luke Hochevar for 2014, just two years after four pitchers had Tommy John surgery performed on them in a two month span in 2012.

Seemingly every year, the number of players that have the surgery has increased. As medical science has improved, and the procedure has become more commonplace, players are coming back stronger than before. It is now rare for a pitcher to come back from Tommy John surgery and have their velocity decrease, with John Lamb being a notable exception.

Looking through the list of players that underwent Tommy John surgery, the last time that a year went by without a player having the surgery was back in 1998. Since then, the number of players that had Tommy John surgery spiked through the early 2000′s before a dramatic dropoff starting in 2005. That spike, from 1999 through 2004, also happened to coincide with the peak of the PED Era in baseball. Perhaps not coincidentally, 2005 was also the year that the Player’s Union and MLB agreed on drug testing. Since steroid and PED use weakens ligaments, that could be a viable explanation for the dramatic increase in Tommy John surgery during that time frame.

Now, after seeing no more than twelve players have Tommy John surgery from between 2005 and 2010, those numbers began to increase. 2011 saw 26 players go under the knife, including Lamb and Juan Gutierrez for the Royals. That number exploded to 46 players in 2012, before decreasing to 23 in 2013. Now, in a month, seven players are going to have Tommy John surgery thus far in 2014.

In a sport that is, at least theoretically, cleaner than it had been a decade ago, why would instances of Tommy John surgery have increased? It may be a result of how hard pitchers are throwing. Very rarely do pitchers who are considered to be soft tossers have the procedure done. With the increased velocity and the unnatural motion of throwing overhand, it may just be that needing to undergo Tommy John surgery is a natural byproduct of baseball’s fascination with pitchers that can reach triple digits on a radar gun. Or, for those who are more cynical, it could mean that players are finding new, and thus far undetectable, PEDs to enhance their abilities.

Should the latter scenario turn out to be accurate, then perhaps keeping an eye on the amount of Tommy John surgeries could be a way for baseball to determine if there is a potential PED problem that they are yet to become aware of. Keeping an eye on those trends could be the best way for Major League Baseball to stay with those players violating the league’s substance abuse policy.

Obviously, not every player that has Tommy John surgery done is taking PEDs. In fact, it is likely that the majority of those players are not. However, in this point in baseball history, when players are being painted with the PED brush for even remotely looking as though they may have taken something once before, it is an unfortunate reality that suspicion could fall upon these players.

This spike in Tommy John surgeries could just be a coincidence, but it is certainly something that could bear watching. As it is, baseball appears as though it is in the midst of another spike in surgeries.

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Tags: Kansas City Royals Tommy John Surgery

  • jimfetterolf

    Back when program training was starting to put hard throwers into the game, the old-school scouts worried that such velocities couldn’t physically be maintained for any but a very few throwers, which is why Tim Lincecum, for instance, fell down the draft. What we are seeing now is that the old-school may have been correct. You can build up muscle but connective tissue is another matter.

    • Dave Hill

      I wouldn’t be surprised if there was a trend towards ‘softer’ throwing starters and an overpowering bullpen across the majors at some point. Perhaps by limiting the amount of innings these pitchers are throwing, they may be able to keep them healthier for longer.

      • jimfetterolf

        Last year’s Crow, Herrera, and Hochevar examples. Hoch and Crow were both long-tossers in college, Royals dialed them back after the draft, they underachieved. Still an open question as to what is the maximum training that delivers both performance and endurance. Seems more pitchers having a second TJS than ever before.

  • unclejesse40

    I wish Hoch would come back as a knuckleball pitcher!! The Knuckleball is one of my guilty pleasures. I know that just sounded really weird but I love watching one of those guys pitch, and I really wish the Royals could find a good one. Plus they can pitch till they are like 50.

    • Dave Hill

      I completely understand. Much like your enjoyment of knuckleball pitchers, I have an affinity for pitchers who are either submariners or throw a screwball. Watching Hector Santiago pitch is a guilty pleasure of mine.

  • 1LoyalRoyal

    I always appreciate the thought behind yours’ and Hunter Samuels posts, and this is another excellent, thought provoking article. I wonder if you might consider another angle to this growing trend, and if over-used arms at the pre-high school, and high school level could be chiefly-responsible? There seems to be a great void at the youth sports level in education and knowledge of how to manage a young arm that in many cases has yet to fully develop (growth plates), and wonder if you were to study arm injuries at this stage, would the curve resemble much of what we are seeing today at the professional level? Perhaps we are just at the beginning of the trend at the professional level? Keep up the good work!