Kansas City Royals and Tommy John Surgery


The Kansas City Royals have announced that Greg Holland has torn his Ulnar Collateral Ligament (UCL) in his elbow and will likely need Tommy John surgery.  Lots of pitchers get this surgery and the recovery is long. Successful surgeries are now more likely since the procedure has been done so much.  What is the likelihood of success?

The first successful operation was done on a major leaguer, Tommy John, in 1974.    He did not pitch in 1975,   It was done by Dr. Frank Jobe, an orthopedist surgeon.  John played for the Indians, White Sox, Dodgers, Yankees, Angels, A’s, and Yanks again.   He made four All Star Teams (1968, 1986, 1988, 1989),

In 1974, John posted a 2.59 ERA. While he missed the 1975 season but then pitched until 1989.  His first year back in 1976, he was 10 and 10 with an ERA of 3.09.  In the next four seasons he got 20, 17, 21, and 22 wins.  The surgery was a success by baseball standard. At the time, the recovery was considered “miraculous.”

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The ulnar collateral ligament joins the humerus (the long bone that goes from the shoulder to the elbow) to the ulna.  The ulna is one of two of the bones in the lower arm.  If your arm is down and the face of your hand is forward, the ulna is the bone in your forearm that is closer to your body. A ligament is a fibrous connection that join bone to bone.

During the operation, holes are drilled in the ulna and humerus bone near the elbow.  They take a non-critical tendon from the other arm or somewhere else (such as the palmeris tendon in the forearm). The surgeon weaves it between the holes in humerus and ulna bones and it is then anchored.  The ulna nerve can  be moved to reduce pain.

While the pitcher Tommy John’s surgery was considered to be a longshot back then, the success rate today is around 85-92% to pitch at the same level after first-time TJ surgery. However, some pitchers eventually may need it again. Thirty-five percent of those with two TJs  do not return to the majors.

During the first 7 to 10 days, the patient may wear a splint to keep the elbow straight . The patients do a gentle range of  motion exercises, including those to strengthen arm and shoulder and body conditioning exercises.  After six weeks, patients move to elbow-strengthening exercises that don’t put too much stress on the graft.

According to WebMD , recovery is usually one year, though sometimes it may be two years.  Like any surgery, there can be complications (for example, the graft may not “take” to the two bones.)

Members of the Royals who had TJ Surgery include Kris Medlen, Joba Chamberlain. and Ryan Madson.  It may be useful for Holland to talk to his three teammates who have already gone through the procedure.

In 2013, prior to his surgery, Medlen posted a 3.11 ERA. With the Royals this year, that ERA is at 3.51. Joba Chamberlain‘s  surgery was June 2011. He started pitching again  on Aug. 1, 2012. Chamberlain had his surgery in 2011.  He made his scar into a smiley face at one point. Madson had his surgery in early 2013.  His missed that season and the next before joining the Royals in  2015, where he has posted a 2.28 ERA.

Next year Holland is arbitration-eligible and, without the injury, he might have looked at a salary around $10 million.  But the injury will complicate the situation in regard to the Kansas City Royals’ offering arbitration,  It is possible he might sign as a free agent with the Royals or another team.

If so, it would be an unfortunate ending to a truly great career with the Royals. Hopefully, Greg Holland will remain in place, signing a contract that will allow him to return after his recovery.

Next: Royals Did Not Mishandle Greg Holland