If you’re a baseball fan, spring training is a time of hope — and anxiety. Every morning, you scan the news nervously, dreading the two most ominous words a headline about your favorite pitcher can contain: elbow inflammation.
Throwing a baseball places an extraordinary amount of stress on the human elbow. And increasingly, the dreaded inflammation is a precursor to the even more dreaded ulnar collateral ligament surgery, which is sometimes called Tommy John surgery, after the first pitcher to receive it. The procedure takes a pitcher off the mound for more than a year — they basically have to re-learn how to throw.
But, as devastating as the surgery can be in the short term, it can also save a career. And because of that, it’s becoming more and more popular.
Hundreds of pitchers have it every season, in 2024, two pitchers per week, on average. On March 14, the Arizona Diamondbacks announced that one of their top prospects, Blake Walston, would miss the entire 2025 season after going under the knife.
For a long time, Tommy John surgery was considered a last resort. But nowadays, it’s not uncommon for pitchers to have it twice over the course of their careers. Teenage athletes are getting it on a regular basis, believing it can salvage their dreams of a multimillion dollar major league career. But is all this major surgery a good thing?
Josh Hustedt, an orthopedics professor at the University of Arizona, has performed a lot of of these surgeries. Hustedt joined The Show to discuss, saying kids are playing so much more baseball early in life that the rate of elbow injuries is exploding — and that athletes should understand exactly what the procedure is before they have it.
Full conversation
JOSH HUSTEDT: We take a ligament from another area of the body, usually in the hand and the wrist, and we weave it in between the two bones, and we put an anchor on one side and an anchor on another, and we reconstruct the ligament. We then let it heal in, rehab the player, and for most people, they're able to come back very well.
SAM DINGMAN: And what is the reason that it takes so long to recover from that particular procedure?
HUSTEDT: Scar tissue is really interesting thing. The first layer of scar tissue kind of lays down very disorganized. That happens within the first 6 weeks to 3 months. But then the scar tissue actually aligns with body stress over time, and that process takes about a year.
So even when I'm operating on somebody anywhere in the body, but particularly in the elbow, I'll tell them you're about 80% better at 3 months, but you're about 90% better at 6 months and 100% better at a year because it takes that amount of time for that scar tissue to realign according to the stress that you're doing. And that's why it takes so long for the pitchers to return.
There is a push to do more repairs and augmentations, so something called an internal brace, which is a, a suture that goes over the top of a repair. So instead of taking everything out and starting over with the reconstruction, there is a push in younger athletes to just put in this suture augmentation with an anchor on either side and use the suture instead of a tendon.
DINGMAN: What, why is that more appealing for a younger player?
HUSTEDT: So it's a much quicker return of function. So, I'll put two instances in front of you. You are a junior pitcher, and it's your junior season, and you really want to play college baseball, and you have an ulnar collateral ligament injury, and you have to choose between getting an internal brace suture augmentation, or a full reconstruction.
The internal brace may allow you to return in maybe even 3 months and pitch the remainder of the season. The reconstruction is gonna take you out the entire season. For that athlete, they may be much more interested in getting back and getting a college scholarship and getting into college. And that recovery time, the reduced recovery time is more important.
DINGMAN: Gotcha.
HUSTEDT: Versus, you know, let's say you're a Major League Baseball player, you're gonna get paid on your contract regardless. And you're, right, your whole goal is just to throw 100 miles an hour again, and you're willing to give it a year. Maybe a reconstruction is a better option for you.
Most of the athletes that we see that are getting these repairs, they're wanting to get back as soon as they can and, and kind of feel out whether or not baseball's going to be a full part of their life or just a part of their life for the next little bit.
DINGMAN: Well, that's one of the things I was wondering is, let's say I'm that pitcher who's about to, you know, play my junior year of high school and it's more important to me to stay on the field. Let's say I believe that baseball is going to be a part of my life for the rest of my life. I want to go pro.
That's part of my goal in, in getting back on the field and getting a scholarship somewhere. If I get that internal brace procedure, am I putting myself in danger of doing even more severe damage further down the line?
HUSTEDT: Potentially, and, and I would say it's more theoretical than, it's a pretty new procedure, so we don't know what the total long-term outcome of that's gonna be. Now, we'll say that the initial studies are very promising and people have been able to return and pitch very well after a repair.
It's not as simple to just say repairs do worse and reconstructions do better. It also depends on the amount of injury that the patient or the person has, and not just the amount of time that they want to get back.
DINGMAN: Gotcha. I know that you're an orthopedic surgeon and not a psychologist, but since you are also a former athlete at a very high level, I would imagine you know something about the competitive headspace and the level of drive that young athletes have to have in order to entertain dreams of doing this professionally.
I guess what I'm saying is I, I feel like a lot of folks at that age, you know, 16, 17 years old have maybe never really had a serious conversation with themselves about what they want their 30s and 40s to look like. They've, they've just thought about shooting baskets or throwing pitches.
HUSTEDT: Yeah.
DINGMAN: So how do you approach those conversations? Is that something that you have to think about?
HUSTEDT: Yeah, I mean, that's the hardest thing that I do. And luckily, I always have their parents there. And luckily for me, I just tell them they're my experience, right? I was a high-level athlete. I was, one of the best in the world. Actually, I was like 15th in the decathlon in the world. I got second at the NCAA championships, and I got really bad problems.
And, you know, I, I was supposed to have surgery on my elbow and I was a 22-year-old yahoo and I was just, you know, doing whatever. And I was very passionate, and I had to make a decision if I was gonna do that professionally or if I was gonna go to medical school, and I went to medical school.
And so maybe I wouldn't have known, right, when I was that age, which direction I was gonna go, but I just try to tell him, “hey, now I don't throw it all. I didn't have surgery, and I do great in my daily life.”
And I just say, “why don't you guys have a full conversation? It's not a, we don't decide this in one sitting. Why don't you go home and, and talk as a family and really kind of decide what you wanna do.”
DINGMAN: But, I'm just mortified envisioning you sitting with one of these kids, maybe talking to them for the first time about the possibility that their dream is not gonna come true. I mean, is, is that a situation you found yourself in?
HUSTEDT: All the time, yeah.
DINGMAN: And how do you get through that? I mean, jeez.
HUSTEDT: It's the, like I said, it's the hardest thing that I do. So it's very easy for me to see somebody with a broken wrist and tell them, “hey, your wrist is broken. Look at the X-ray, let's fix it.”
It's very different to have an honest and open conversation with somebody about what their future looks like when in reality they don't know what it is. My goal with my patients is that it's a patient choice. My job is to educate you on what your options are and then to support you with the best option that you choose.
DINGMAN: Yeah. Yeah.
HUSTEDT: Not easy.
DINGMAN: Yeah. What do you think should be done about this? Like in these early stage sports leagues where kids are starting down these paths that you've described of playing one sport to the exclusion of others, what do you think?
HUSTEDT: This is just the doctrine of Josh, but I do think that it's good for kids to do cross training. So, particularly when they were young and when I was an athlete, I spent a lot of time cross training to try to keep my body fit and not to overwhelm any one particular area of my body.
And I think that if you're a parent and you're hearing this, I would just strongly encourage your children to continue to participate. It doesn't have to be in other sports, but just not going out and throwing hard every day when you're developing, particularly between the ages of 12 and 16, your body has a lot of changes and maturation that's happening during that time, and it's good to just try to be as global as you can and have them participate in other activities other than just throwing.
Take it from the decathlete, right? There's more than one way to be an athlete.
DINGMAN: That's right, absolutely.
