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Posted at 04:09 PM ET, 10/26/2011

Tommy John surgery: Pitchers can be better than ever afterward

In his last appearance of 2011, Stephen Strasburg pitched in Miami. (Mike Ehrmann / Getty Images)
Before 1974, a pitcher with a torn ulnar collateral ligament was a former pitcher. But 37 years ago Dr. Frank Jobe performed ligament-replacement surgery on Tommy John and everything changed.

Today, pitchers like Stephen Strasburg and Jordan Zimmermann of the Washington Nationals are back at work. A year ago, 10 pitchers who had undergone the surgery were named to baseball’s all-star team.

“As long as it’s in the right hands,” Tim Kremchek, a leading Tommy John surgeon told The Post’s Adam Kilgore this summer, “the player has over a 95 percent chance of coming back.”

The latest to have the surgery, in which a tendon from the thigh is transplanted in the elbow, will be Boston Red Sox starter John Lackey, who is expected to return in 2013. Overall, more than 150 baseball players, by the Sporting News’ count, have had the procedure.

Chris Carpenter of the St. Louis Cardinals. (MIKE SEGAR / Reuters)
Some pitch with more power; others struggle. Chris Carpenter, John Smoltz, A.J. Burnett, Joakim Soria, Francisco Liriano, Josh Johnson, David Wells and Tim Hudson are on one side; Kris Benson, Pat Hentgen and Kerry Wood are on the other. (Mariano Rivera did not have the procedure.)

“I would never have thought it would happen,” said Dr. Frank Jobe, a friend of Tommy John and the orthopedic surgeon who pioneered the surgery, told Kilgore. “It’s been a very fortunate experience for me. It just turned out very well.”

Four things, according to Kilgore, have improved the success rate of the procedure:

●The placement of the tendon graft has become more uniform, which leads to fewer complications for surgeons.

●The operation is less invasive and requires less damage to soft tissue. Doctors no longer cut the elbow wide open, as Jobe did for John.

●Surgeons don’t move the ulnar nerve anymore. About 10 percent of recoveries once either failed or were slowed because of nerve damage. Surgeons learned how to operate around the nerve.

●The most significant development has been a more predictable and comprehensive rehab plan. Pitchers still throw for the first time at around 16 weeks after surgery. Doctors now, though, have a better understanding of how pitchers should strengthen their shoulder and core muscles to take stress off the elbow.

By  |  04:09 PM ET, 10/26/2011

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