Which Tommy John Surgery Is Best? Answer: Neither! (Orthopedics This Week)
It’s a first-in-the-literature…Jim Bradley, M.D., M.S., a sports medicine specialist with Burke & Bradley Orthopedics at the University of Pittsburgh Medical Center and lead physician for the Pittsburgh Steelers, has conducted a head-to-head trial of two types of Tommy John procedures. Dr. Bradley tells OTW, “We conducted a prospective randomized clinical trial comparing a modified Jobe technique (as taught to me by Frank Jobe), to the docking technique that was developed by David Altchek. We had an equal number of baseball players in each group—88% docking procedure and 84% of those who had the modified Jobe returned to play at the same level. All baseball players had complete tears of their UCL [ulnar collateral ligament] and no prior surgeries on the ipsilateral shoulder or elbow.”
“This study, which was conducted with high school and college baseball players, is the first one in the literature to prospectively compare the modified Jobe versus a docking technique by one surgeon, one institution, and one rehab protocol. While the majority of players did well, there was a 12-16% failure rate, which is consistent with the literature. Most lay people think that when someone undergoes a Tommy John procedure they come back better and stronger, something which has been proven untrue by multiple studies. When treating a patient with a partial ulnar collateral ligament tear I often hear, ‘Why don’t you just fix the arm so that it will be stronger?’ Well, it’s because it won’t necessarily be stronger!”
“It should be noted that there are different scales used to measure an athletes’ ability to return to play. There is the Conway scale, the Andrews-Timmerman score, the Kerlan-Jobe Orthopaedic Clinic score, and the American Shoulder and Elbow Surgeons score. For this study we used the Conway score because it is very specific to overhead athletes.”
“At present we are building up our numbers. I do approximately 30 such surgeries annually, so it takes a while to attain higher numbers. Our goal is to have 30 enrollees in each group.”