September 23, 2024

WATCH: THREE STRIKES, NOT OUT DOCUMENTARY

Reds broadcaster John Sadak talks with Dr. Timothy Kremchek of Beacon Orthopaedics & Sports Medicine about the 50th anniversary of the first Tommy John surgery. Dr. Kremchek reflects on the groundbreaking procedure, its impact on baseball, and how it revolutionized sports medicine. He discusses the surgery’s evolution, modern recovery times, and the rise of repeat surgeries, like in the case of Reds pitcher Tejay Antone. Dr. Kremchek also touches on the growing emphasis on velocity in pitching and the challenges that pose for player longevity.

Transcript

John Sadak:
Well, today marks 50 years since the first Tommy John surgery, performed on Tommy John himself. Can you give us some insight? What was the medical field like back then, and what kind of impact did this procedure have on the game?

Dr. Timothy Kremchek:
I was in seventh grade when that happened, so I didn’t really know what Tommy John surgery was until probably the early ’90s—and a lot of people didn’t. But I’ve gone on record saying that two of the biggest advances in sports medicine over the last 50 to 75 years, in terms of keeping athletes on the field, are the ACL reconstruction and the Tommy John procedure, pioneered by Dr. Frank Jobe in 1974.

The surgery on left-handed pitcher Tommy John revolutionized how we manage athletes, particularly pitchers, and it’s become almost an epidemic over the last few years.

John Sadak:
From what I read, there was only about a 1% chance that Tommy John would ever pitch again. Tell us about those first few years after the surgery. How many major leaguers had it done, and how does that compare to today?

Dr. Timothy Kremchek:
When Tommy John injured his elbow, there was no cure at the time. Pitchers like Sandy Koufax had to leave the game because of similar injuries. Dr. Jobe, a polio specialist at Centinela Hospital in Los Angeles, performed the surgery. Getting to know Dr. Jobe has been one of the great honors of my career. He’s rightfully in the Baseball Hall of Fame. Tommy John, after a second surgery to move a nerve, came back and won more games post-surgery than before.

But think about this: If that surgery hadn’t worked in 1974, where would we be now? In the first 10 years after the procedure, only 12 players had it. But in the early ’90s, it started to take off as success rates improved. Today, around 36% of Major League Baseball pitchers have undergone Tommy John surgery.

John Sadak:
What’s the recovery timeline like now, from surgery to getting back on the field? What does the rehab process entail?

Dr. Timothy Kremchek:
It’s interesting. I spoke with Tommy John about 10 years ago, and the rehab he went through in 1974 is quite similar to what we do now, which is surprising. 

Surgically, we’ve made tremendous advancements, but the rehab remains consistent. It’s about 4 to 6 months before pitchers start throwing again, and it takes about a year to fully return to form.

For instance, a couple of Reds pitchers— [Connor] Overton and [José] Sanmartín—had the surgery last year, and they’re both pitching in Triple-A now. We’ll see if they get a call-up, but typically, the full recovery is around a year.

John Sadak:
You’re involved in a significant effort with Tejay Antone, who’s attempting to come back after multiple surgeries. Can you share more about that?

Dr. Timothy Kremchek:
The longevity of a Tommy John surgery is typically around six to seven years. We’re now performing revisions on athletes whose ligaments have torn again. Tejay is a unique case because he tore his ligament twice and underwent a third reconstruction. We’re not sure how this will play out. Tejay has been working hard to document his journey to educate others. I give him credit—he asked me to help, and I’m happy to be part of it.

Unfortunately, I think we’re going to see more players needing two or three Tommy John surgeries as they try to return to the game. The allure of the big leagues is strong.

John Sadak:
There are reports of some athletes electing to have Tommy John surgery, hoping for a performance boost. What’s your view on that, and what impact does the surgery have on the ligament and throwing mechanics?

Dr. Timothy Kremchek:
What we’re doing is replacing the torn ligament on the inside of the elbow with a graft, much like we do with ACL reconstruction. Over time, the tendon we implant turns into a ligament. We’ve developed newer techniques, like using an internal brace for repairs or revisions. Some players, like Justin Wilson, have had what we call a “hybrid,” combining a ligament graft with the internal brace. It’s worked well, but the rehab process remains largely unchanged.

John Sadak:
Where do you see this procedure heading in the future?

Dr. Timothy Kremchek:
Unfortunately, I think the number of surgeries will continue to rise. The main issue is pitchers throwing too hard and too often. We’ve become obsessed with velocity. If a high school or college pitcher doesn’t hit 90 mph, they’re often overlooked. The days of pitching with finesse—hitting corners, changing speeds—like Greg Maddux or Tom Browning did, seem to be fading.

As long as we prioritize velocity, pitchers won’t last. We need to focus on mechanics and pitch control across all levels—Major League, minor league, college, and high school. If a pitcher throws 90+ mph in high school, it’s only a matter of time before they need Tommy John surgery. And if they require a second or third surgery early in their professional career, we don’t yet know the long-term outcomes.

Preventing these injuries is key. Hard throwing, combined with the slickness of today’s baseballs, has made it more difficult. Players like Sonny Gray and Tejay Antone will tell you that gripping the ball tighter increases stress on the muscles protecting the elbow, making the ligament more vulnerable. We need to address this at the Major League level to keep star players healthy and on the field.

WATCH: THREE STRIKES, NOT OUT DOCUMENTARY