Tommy John Surgery: History and Recovery

By 4Baseball Staff · November 5, 2026 · 10 min read

How a 1974 experimental operation on a Dodgers pitcher became a routine fixture of professional baseball, with Tommy John's own career in the historical record, the typical recovery timeline and what workload data can and cannot show.

In the summer of 1974, Tommy John was 13-3 for the Los Angeles Dodgers and pitching as well as he ever had. Then he threw a pitch and something in his left elbow gave way. In an earlier era that would have ended his career. Instead, in the fall of 1974, the Dodgers' team physician, Dr. Frank Jobe, tried an operation nobody had performed on a ballplayer: he replaced the damaged ligament in John's elbow with a tendon taken from elsewhere in his body. John missed the entire 1975 season, came back in 1976, and went on to win 164 more games. The operation now bears his name, and for a pitcher with a torn ulnar collateral ligament it is the standard repair.

This article is a history and an explanation, not medical advice. It describes what the surgery is in general terms, tells the story of its first patient using the historical record, sets out the timeline recoveries are commonly said to follow, and looks at what league-wide workload numbers suggest about why the operation became so common. Anyone with an arm injury, or a young pitcher with elbow pain, should see a doctor, and parents and coaches should follow their league's published pitching guidelines.

The surgery sits at the point where the science of throwing meets the economics of the game. A pitcher's arm is a major-league club's most valuable and most fragile asset, and the story of Tommy John surgery is, in a way, the story of how baseball learned to protect it, and how it has not always succeeded.

What the surgery repairs

The ligament at the center of the story is the ulnar collateral ligament, or UCL, a band of tissue on the inner side of the elbow that connects the upper arm bone to the bone of the forearm. When a pitcher throws, the elbow is subjected to a large force that tries to open the inside of the joint, and the UCL is the main structure that resists it. Repeated stress can fray the ligament over time, or a single hard throw can tear it.

The operation is formally called UCL reconstruction. The surgeon drills small tunnels in the bones on either side of the elbow and threads a replacement tendon, called a graft, through them to form a new ligament. The graft is usually taken from the patient's own body, such as a tendon in the forearm or hamstring, or occasionally from a donor. Over the following months the graft heals and remodels into the elbow. Details of technique have changed since the 1970s, and newer approaches and add-ons have appeared, but the basic idea of replacing the ligament with a tendon is the same.

This is not a procedure that can be explained in a few paragraphs, and decisions about who needs it and when are for physicians. What matters for a baseball reader is the consequence. A torn UCL once meant the end of a pitching career. After 1974, it came to mean a long absence followed, usually but not always, by a return.

Before 1974: a torn elbow ended a career

Before the operation existed, a pitcher whose elbow went could rest it, try to pitch through pain or retire. Many careers ended in the 1960s and early 1970s with a loss of arm strength that was never fully explained, and the phrase "dead arm" covered a range of problems that nobody could repair. Tommy John, a left-hander who had debuted in 1963 with Cleveland, was not an exception waiting to happen. He was a durable pitcher with a career already well under way.

The historical record gives his line. Before the injury he had pitched for Cleveland in 1963 and 1964, for the White Sox from 1965 to 1971 and for the Dodgers from 1972. His seasons with the White Sox include 14-7 with a 3.09 ERA in 1965, 14-11 with a 2.62 ERA in 1966, 10-5 with a 1.98 ERA in 1968, and 12-17 in 1970 while pitching 269 1/3 innings. With the Dodgers he went 11-5 in 1972, 16-7 in 1973 and 13-3 with a 2.59 ERA in 1974. In the 1960s and 1970s, a good starter regularly pitched 200 or more innings, and John did.

By the time of his injury he had won 124 games. Nothing in that record shows a pitcher at the end of the road.

The operation: Frank Jobe and the first patient

Dr. Jobe, the Dodgers' orthopedic surgeon, had been working on ways to repair ligaments, and he proposed a graft that had not been tried on a professional athlete. John agreed to the operation. It was experimental, with no guarantee of success, and Jobe and John worked out a long rehabilitation. Whatever the exact odds were, it was a gamble on both sides.

John did not pitch in 1975. In the historical record his year-by-year line goes straight from 1974 to 1976, with no entry for the intervening season. He returned in 1976 and went 10-10 with a 3.09 ERA in 207 innings. In 1977, at age 34, he went 20-7 with a 2.78 ERA in 220 1/3 innings, and in 1978 he was 17-10 with a 3.30 ERA. He moved to the New York Yankees in 1979 and had his best seasons: 21-9 with a 2.96 ERA in 276 1/3 innings in 1979, and 22-9 with a 3.43 ERA in 265 1/3 innings in 1980.

The arithmetic is striking. He won 124 games before the operation and 164 after it, and his career total of 288 wins came in a career that lasted until 1989. He pitched in 760 games, started 700 of them and finished with 162 complete games. He was an All-Star in 1968 before the operation and in 1978, 1979 and 1980 after it. The historical record lists the Hutch Award for 1976, honoring his comeback, and the Lou Gehrig Memorial Award for 1981.

John's career is not proof that the surgery works for everyone, any more than one patient is proof of anything. But it showed that the operation was possible, and it changed the way players, doctors and clubs thought about an injury that had been a death sentence.

How the operation spread

After John, other pitchers underwent the surgery, and as the technique improved it became a more predictable procedure. By the time of the early 2000s, it was a routine part of professional baseball, and in recent years it has been performed on pitchers at every level, including high school.

The historical record does not record injuries, so it cannot count how many pitchers have had the surgery. What it can show is the gap in a pitcher's career. Stephen Strasburg, the first overall pick in the 2009 draft, pitched in 12 games for Washington in 2010, then had the operation. His 2011 line shows only five games, 24 innings and a 1.50 ERA, a September comeback. In 2012 he made 28 starts, won 15 games and struck out 197 batters in 159 1/3 innings.

Justin Verlander's case is a later and older example. In 2020 he made one start for Houston, going 1-0 in six innings. In 2021 he did not appear in the database. In 2022, at an age when many pitchers are declining, he returned to go 18-4 with a 1.75 ERA in 175 innings and won the American League Cy Young Award. His career, like John's, shows that the gap in the record is not always the end of the story. Individual outcomes vary, and these examples are chosen because they returned, not because every pitcher does.

The recovery timeline

The details of recovery belong to doctors and physical therapists, and every patient and surgeon works differently. In general terms, public reporting on pitchers who have had the operation describes a staged process that lasts a year or more.

The first stage is protection. The elbow is immobilized or limited for a period while the graft begins to heal, and the patient works on regaining range of motion and strength in the rest of the arm, shoulder and body. The second stage is gradual strengthening. As healing proceeds, therapy adds resistance exercises and conditioning. The third stage is a structured throwing program, usually beginning with short, easy tosses and slowly increasing distance and intensity over months. The fourth is a return to the mound, often with bullpen sessions and a series of rehabilitation starts in the minor leagues before a major-league return.

The commonly reported time for a pitcher to return to a major-league mound is a year to eighteen months, and some take longer. The records above fit that picture: John missed one full season, Verlander parts of two. Individual timelines differ, and a pitcher who is rushed may risk reinjury. If you are a patient or the parent of one, the surgeon's protocol, not a general article, is the guide.

There is also a cost to the club. A pitcher on a long rehabilitation takes up a roster spot, usually on the injured list, and still draws a salary. Clubs plan around the possibility, and the draft sometimes includes pitchers already recovering from the operation because their talent is worth the wait. For how that process works, see how the MLB draft works.

Why the operation became common: what the numbers can and cannot say

It is natural to ask why so many pitchers need the surgery, and the question has no settled answer. What the historical record can show is how pitching has changed over the decades, which is part of the context even if it is not the explanation.

The table is computed from league totals for the American and National Leagues, and the number of clubs grew from 20 in 1965 to 30 in 2005 and later, which is why the last column is per club. It shows three things. Complete games have almost disappeared: in 1975, about 27 of every 100 starts were finished by the starter, and in 2025 fewer than one was. Strikeouts per nine innings have risen from about 5 to nearly 8.5. And the number of different pitchers each club uses in a season has roughly doubled since the 1970s, from about 14 to about 29, as clubs spread innings across more arms. That column counts different pitchers who appeared for any club in the league, divided by the number of clubs, so it is a rough measure.

Those facts suggest a game in which pitchers throw fewer innings each but throw each pitch with more effort, and in which a larger share of the arms in the sport are asked to do so. Whether the intensity of the throws, the number of pitches, the amount of year-round throwing in youth baseball or some other factor is the main cause is a question that medical researchers continue to study, and the historical record cannot settle it. It carries no pitch counts, no velocities and no injury records. Anyone who tells you that a single factor explains the trend is claiming more than the evidence supports.

Pitch types come up in the discussion as well. Many fans suspect that breaking balls are especially harmful, but the evidence on that has been mixed, and the question is separate from the physics of how a curve moves, which you can read about in the physics of a curveball. The practical lesson for youth coaches is not to ban a pitch on a hunch but to follow the league's guidelines and listen to the player.

Protecting young arms

Elbow injuries are not limited to professionals, and the operation is performed on teenagers. For parents and coaches, the guidance from the sport's governing bodies is the starting point. Major League Baseball and USA Baseball publish the Pitch Smart guidelines, which give recommendations on pitch counts and rest days by age, and Little League International publishes its own pitching rules. Follow your league's rules exactly, and when in doubt, choose more rest.

General principles that appear in those guidelines include limiting the total number of pitches thrown in a game and in a week, taking rest days, avoiding pitching on multiple teams at once, not throwing when tired or in pain and taking time away from the sport during the year. A child who reports elbow or shoulder pain should stop throwing and see a doctor. None of this is a guarantee, and no routine can make injury impossible, but these steps reduce risk.

Equipment is part of the picture too, though not for the elbow itself. The history of baseball safety, from the batting helmet to catcher's gear, is mostly a story of protecting players from being hit. Tommy John surgery is different: the damage comes from the act of throwing, and the protection is workload, rest and technique.

Common questions

Who was the first player to have Tommy John surgery? Tommy John himself, in 1974, performed by Dr. Frank Jobe. The historical record shows no 1975 season for him, and a return in 1976.

Does the surgery make a pitcher throw harder? A popular belief holds that it does, but the idea is not established, and the record of pitchers returning is mixed. It is best treated as a repair, not an upgrade.

How long is the recovery? Public reporting describes a year to eighteen months for most pitchers, sometimes longer. The surgeon's plan governs any individual case.

Can a pitcher have it more than once? Some have. The details are medical and vary by case, and the historical record does not track it.

Is it only for pitchers? It is mostly associated with pitchers because of the stress of throwing, though other athletes can also injure the ligament.

Where to go next

Browse injury news in the injuries topic feed, look at how pitchers' numbers have changed on the league leaders pages, and find your child's league guidelines through the youth baseball section. For related science, read the physics of a home run and altitude, weather and baseball at Coors Field, and for how an unusual rule can decide a standings race, how MLB tiebreakers work.