The Raise in Tommy John surgery in Youth Baseball


   The shocking raise in youth baseball players needing reconstructive Tommy John surgery has been on the raise for the last decade. With changes in pitching styles in the MLB over the last 20 years. Pitchers are being asking to throw harder then ever and places a high amount of spin on the ball that places a tremendous amount of torque on the elbow. 

    The ulnar collateral ligament (UCL) is a small ligament on the inside of the elbow that connects the ulna bone (forearm) to the humerus bone. In children the ligament is under developed, the repetitive  stress of throwing a baseball as soon as the age of 4 years contributes to the raising number of injuries for players under the age of 15. 

    Tommy john was a dodger pitching that received the first successful reconstructive surgery of the UCL that saved his MLB career. The tearing of the UCL before was a career ending injury. In today's advances in medicine players are receiving multiple reconstructive surgeries and being able to play at a high level.

“Tommy John surgery is a reconstruction, meaning you're making a new ligament of the ulnar collateral ligament of the elbow. So that's the inside portion of the elbow, or the medial side of the elbow,” Dr. Moutzouros said. Over time, pitchers “typically injure this ligament. They stretch it out or completely tear it and that requires us to remake it.”

“In any ligament reconstruction you take a ligament or a tendon or a graft from somewhere else in the body,” said Dr. Makhni. “Often we use a ligament from the wrist—called the palmaris longus or a hamstring tendon—and we weave it into the two bones to where that UCL used to be, and we hold it in place through drill tunnels and sutures and we recreate that tendon.”  

“It’s not the easiest surgery because the elbow is a really difficult joint to operate on,” Dr. Moutzouros said.

    Todays youth baseball programs have put in places multiple programs to limit the amount of pitches a player can throw with a mandatory days of rest. With the programs in place the injury continues to require thousands of young baseball players to have reconstructive surgery on their elbow. So what extra precautions can we take to prevent damage to a players elbows? 

  • Don't allow pitchers to throw types of pitches that place a high amount of stress on the UCL till the players body starts to develop. You can search what pitches are appropriate for each age group. 
  • Be mindful of the amount of throwing the players does at home, practice, lessons and games. The stress is not only generated a games. Allows periodic breaks to allow the tissues to heal.
  • Establish boundaries with coaches to not over use the players arm for the sake of a little league game. 

    With the world as a whole always pushing to bigger, faster and stronger then the next has caused a lot of injuries and death to players. As coaches and parents it is ok to push our players, but understand the limits. 





12, J., & Berg, S. (2024, July 12). What doctors wish patients knew about Tommy John surgery. American Medical Association. https://www.ama-assn.org/delivering-care/public-health/what-doctors-wish-patients-knew-about-tommy-john-surgery

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