Last week Dr. Frank Jobe, the orthopedic surgeon who pioneered the “Tommy John surgery” that has revived and extended the careers for hundreds of MLB pitchers and athletes in other sports, passed away. The surgery is named after Tommy John, the Los Angeles Dodgers pitcher who was the first recipient of the experimental procedure – after the surgery and rehabilitation process, John went on to play 13 more seasons and win 164 additional games.
Dr. Jobe is a shining example of using the Kaizen mindset, to challenge the status quo and try something that hasn’t been done before and realize rewards and success resulting from taking such a chance. Without it, there are thousands of athletes whose careers would have been cut far shorter than they turned out to be.
So how did his original Ulnar Collateral Ligament (UCL) replacement surgery process unfold? If you think about it, it’s very PDSA.
– When pitchers would tear a tendon or ligament in their elbow prior to 1974, their careers were effectively over. Dr. Jobe thought there could be a way to fix the damage.
Dodgers pitcher Sandy Koufax had his career cut short by a similar elbow injury in the 60s and he was out of baseball by 30 years old. His story of being forced to leave the game due to injury was not unique. In 1968 Dr. Jobe became the Dodgers’ orthopedic doctor.
After John tore his UCL in July 1974 and had his elbow in a cast, Dr. Jobe saw that proper healing through rest was not going to occur and that something drastic would have to happen for a full recovery.
He had assisted other doctors on ligament transfers in patients prior, such as ankle ligaments with patients suffering from polio, but had never done one for a baseball pitcher. Baseball players being the athletes they are, it would be a challenge to find a suitable tendon to use that did not take away the ability to run or throw. Fortunately he found one – an unused/unneeded tendon in the opposite wrist (the glove hand) of a pitcher.
– Using the research he had done with surgeons from other walks of life, he crafted the plan that offered the best chance of short-term success with limited resulting damage and performed the surgery.
Since Tommy John was a left-handed pitcher, he would transfer a ligament from his right wrist to his left elbow to replace the torn UCL. In September of 1974 he performed the surgery.
“Would it stay there? Would it receive blood vessels? Would it become part of his elbow? We didn’t know,” he says. “That’s why I told (John) he had about a one in 100 chance, and (John) said, ‘Well, if I don’t do anything, I’ve got zero chance.’
“And then he came in about a week later and said, ‘Let’s do it,’ and those words pretty much changed sports medicine.”
That’s something often forgotten with taking chances. You might have low odds of success when taking a chance, but you might have zero chance of success by not taking the chance at all.
– He and John controlled the rehabilitation process, monitoring how well the replacement tendon was grafting to the new elbow location.
Being in uncharted medicine waters, Dr. Jobe and John worked together to monitor whether the surgery would create the short term grafting effects they had hypothesized. Physical therapy was also facilitated by the team trainer. It was rigorous and closely checked and studied.
The short-term effects of the tendon grafting properly were confirmed. The long-term effects, however, were still unclear. Would John ever be able to pitch again, and if so for how long?
– Because he wasn’t sure how well the surgery would hold up long-term, he didn’t perform another UCL surgery until a couple years after seeing the amazing success Tommy John had post-surgery.
On April 16th, 1976, Tommy John made his first appearance in MLB since the surgery. He would go on to throw 207 innings in the majors that year with no side effects from the surgery. He would pitch until 1989 when he retired at age 46. The long-term success of the surgery were clear and has since been duplicated time and time again by other doctors.
Thanks to Dr. Jobe and his Kaizen thinking, elbow injuries are no longer the death knell of baseball careers. In fact, Tommy John surgery helps undo a lot of past damage and reinforces the elbow to be stronger and more effective prior to injury. It’s almost like a fountain of youth for pitchers.