Tommy John surgery

This does not strike me as being a good thing.

While rates on UCL surgery are not tracked nationally, some of the area's and country's top surgeons said they've seen a significant increase in the number of high-school-aged players having the procedure.

"I would say over the last five to seven years, (the rate) has doubled," said David Lintner, an orthopedic sports medicine specialist who is Eovaldi's doctor and also serves as the Astros' team medical director. "And it goes up steadily every year."

Dr. James Andrews, one of the nation's most respected orthopedic surgeons, has also seen a spike in the number of high school pitchers he has performed the procedure on.

In a three-year span from 1996-99, Andrews performed Tommy John surgery on 164 pitchers, 19 of whom were high school aged or younger. From 2004-07, that number had jumped to 588 pitchers, 146 of whom were high school or youth league players -- a seven-fold increase.

"Without a doubt, it's an issue," said Glenn Fleisig, the Smith and Nephew Chair of Research at the American Sports Medicine Institute, which was founded by Andrews. "The numbers are staggering in adolescents. More and more high-school-aged kids are having the surgery."

The big question: Why is a procedure once used mostly on college and professional players becoming more prevalent in kids who can't legally vote?

There are many factors, including how much a pitcher throws, what type of pitches he throws and whether he has good mechanics. But one factor stands out as the main culprit.

"Without a doubt, the No. 1 statistical cause (of UCL injuries) is overuse," Fleisig said. "In our studies, when a pitcher regularly threw with arm fatigue, he was 36 times more likely to be in the surgery group as opposed to the non-surgery group. That's the strongest statistical correlation in any study we've ever done."

Back when I was coaching Little League, there were very strict rules about pitcher usage. No more than three innings in a single outing, no more than six innings in a week (or something like that; I forget the exact amount). We were dealing with 9 and 10 year olds, and this seemed eminently reasonable to me. I think the real problem here, and it's discussed later in the article, is that kids are playing year-round, in competitive leagues and tournaments, and in those situations, short-term concerns - i.e., winning this game or this league or this tournament - will take precedence over any one kid's long-term well-being. I think the only thing that can be done about this is for parents to recognize that they're not only not doing their kid any favors, they may be actually harming his future in the sport, and for coaches at the high school level to do what they can to discourage this kind of overuse for their kids. I suspect that as with the idea of pitch counts being important, this will take awhile to catch on.

Posted by Charles Kuffner on April 24, 2008 to Baseball