Pitcher, doctor change baseball

The trajectory of the 2012 Major League Baseball season — when big-name pitchers like Stephen Strasburg, Adam Wainwright and Joba Chamberlain are continuing comebacks from major elbow surgery — could well have been determined one July evening at Chavez Ravine nearly 40 years ago, when a Los Angeles Dodgers ace lefty reared back, fired a sinker and felt his left arm go dead.

At the time, Tommy John had no idea what had just happened. He didn’t know this moment eventually would change baseball history; he only wanted to get out of the fourth inning.

John was 13-3 just before the 1974 All-Star break with a stellar ERA of 2.59, arguably the best pitcher on a Los Angeles Dodgers team that would go on to win the pennant.

He had a 4-0 lead on the Montreal Expos when he threw a 1-1 sinker. The ball came out of his hand and nearly flew into the stands. It was the strangest and most painful sensation he’d ever felt in his left elbow. John threw another sinker. Same result.

After pulling himself out of the game, John went to the trainer’s room at Dodger Stadium. The team doctor, Frank Jobe, took one look at John’s left arm and knew: John had torn a ligament in his elbow. This was bad. The accepted wisdom at the time was rest a bit, come back and you’ll be fine.

But after a month of rest, John’s arm still hadn’t healed. When he tried pitching batting practice, he couldn’t get the ball to home plate.

That was when Jobe proposed something radical: a surgery on John’s elbow that would take a tendon from another part of his body and string it where that torn ligament used to be. Jobe knew the concept was sound, knew these sorts of things could be done because of prior work with polio patients.

Jobe also knew it had never been tried on a big league pitcher.

The risks? Jobe was clear. If John didn’t have surgery on the elbow, he’d never pitch again in Major League Baseball.

And if John did have the surgery?

Jobe gave him a one in 100 chance of ever pitching again. Tommy John began to ponder the possibilities of life after baseball: He could work at a friend’s jewelry store in San Francisco. Or he could work at a friend’s car dealership back home in Terre Haute, Ind. Or he could become a baseball coach.

When it came down to it, there was no choice. Tommy John was a pitcher. If the surgery didn’t fix his elbow, John schemed that maybe he could track down the old knuckleballer Hoyt Wilhelm and learn how to reclaim his pitching career while only throwing 60-mph junk. Pitching, after all, was what Tommy John knew. Since he was 8 years old, baseball was what he loved.

“He looked around my office very seriously,” recalled Jobe, now 87 and retired from Kerlan-Jobe Orthopaedic Clinic in Los Angeles. “He looked me in the eye and said, ‘Let’s do it.’ And those are three words that changed baseball.”

One year and one day after the revolutionary ulnar collateral ligament reconstruction surgery that soon would bear his name, John took the mound in his first rehabilitation start.

Thus began Act II in Tommy John’s sensational career: 288 wins — 164 of those after his surgery — more than 2,000 strikeouts, pitching in the big leagues until age 46 without missing a start from elbow pain.

Tommy John’s second act paved the road for more than 150 second chances for Major League Baseball players since then. Most are pitchers who’ve worn through the ligament in their throwing elbow from repeated use.

Some have called Tommy John surgery the biggest change in baseball since the development of the breaking ball.

While that may be a stretch, the list of current major-league careers extended by the surgery is mind-boggling: Chris Carpenter, Tim Hudson, Francisco Liriano, Shin-Soo Choo, Brian Wilson. Some 11 percent of active big league pitchers have undergone the surgery.

“It’s unreal, isn’t it?” Tommy John, now a 68-year-old grandfather of two living in New Jersey, recently told FOXSports.com. “It’s like when you go to Vegas, you’ve won $1,000 and you put the original money back in your pocket. Now you’re playing with their money.

"That’s what I was doing in baseball. I was playing with the house’s money. I was doing what I had done my entire life, only this time I knew that it was the house’s money, and not my money.”

Since then, the surgery has remained remarkably similar, except that what took Jobe four hours in 1974 now takes surgeons less than an hour.

Jobe took a tendon from Tommy John’s right, non-throwing wrist (tendons in the ankle or hamstring can also be used) then sliced into John’s pitching elbow. He drilled holes in a few spots in the elbow, and then looped the new tendon through those drilled holes in a series of figure-eight patterns. During the long rehabilitation process that included range-of-motion exercises, Tommy John’s tendon learned to act like a ligament.

“Afterward, it was basically: ‘Why didn’t I think of this before?’” Jobe said recently. “Sandy Koufax told me, ‘Why didn’t you think of this when I screwed up my elbow?’ When you look at it from a retrospective view, it was pretty simple. What was so great about it? It was great to have a patient like Tommy John, someone who understood what we were doing.”

Not to mention a patient who worked his tail off to get back in pitching shape.

As he was rehabilitating, John knew he couldn’t overthrow with this new ligament. So he started by throwing to his wife 30 feet away; he knew he wouldn’t whiz fastballs at her. Then he threw to his next-door neighbor. Then it was spring training, and he threw against a wall at Dodgertown, threw until he got tired.

By All-Star break, his arm was starting to feel right again. And one hot summer evening in Pittsburgh, John decided to step it up a notch in a bullpen session, and he kept throwing and throwing, some 45 minutes. He felt good. The bullpen catcher told John his ball finally had some pop on it. That was when John knew this surgery was a success.

“A lot of times we take baseball for granted,” John said. “That it’s always going to be there. I had it taken away from me. So if I got a chance to pitch again, I was not going to let it go without a fight.”

Who knows what will come of the second chances for pitchers coming back from Tommy John surgery this season? Maybe 49-year-old Jamie Moyer will pitch well into his 50s; maybe he’ll flame out by May. Maybe Daisuke Matsuzaka will regain the dominant form of his first season with the Boston Red Sox after getting a new ligament; maybe he’ll be the lackluster pitcher of recent years. Maybe Strasburg will use his bionic elbow and head to the Hall of Fame; maybe he’ll be the most hyped mediocre pitcher of all time.

But know one thing: It’ll take a helluva run for any of these pitchers to beat the post-surgery accomplishments of this surgery’s namesake. Because after four decades, do you know who has the most wins for a pitcher who has undergone ulnar collateral reconstruction surgery? That record still belongs to Tommy John.

You can follow Reid Forgrave on Twitter @reidforgrave, become a fan on Facebook or email him at reidforgrave@gmail.com.