News
Gerrit Cole and the Growing Trend of Tommy John Surgery
Date posted: 3/10/2025
Last updated: 3/10/2025
Article by Nikhil Verma, MD — Head Team Physician for the Chicago White Sox
One of the biggest stories in baseball right now is the news that Yankees ace Gerrit Cole will undergo season-ending elbow reconstruction surgery, commonly known as Tommy John surgery. After managing to avoid the procedure last year while dealing with elbow inflammation, Cole ultimately couldn't stave off the inevitable. Now, he joins a long list of elite pitchers who have had to undergo this career-altering procedure.
The history and significance of Tommy John surgery
While devastating in the short term, Tommy John surgery has been one of the most significant advancements in sports medicine since it was first performed by Dr. Frank Jobe on pitcher Tommy John in 1974. Dr. Lou Yocum, a pioneer in the field, played a crucial role in refining the technique, making it a standard solution for elbow ligament injuries. Since its introduction, UCL reconstruction has saved the careers of hundreds of pitchers, allowing them to return to high-level, productive Major League Baseball careers.
Understanding the procedure and recovery process
The procedure itself involves replacing the damaged ulnar collateral ligament (UCL) in the elbow with a tendon graft, usually taken from another part of the patient’s body or from a donor. While the success rate is high—around 90% of pitchers are able to return to the mound—the recovery process is lengthy. On average, pitchers need about 14 months before they are fully cleared to return to competition and even longer to regain their peak form.
The rise of UCL repair with internal bracing
However, advancements in surgical techniques have opened the door for an alternative option for younger players with certain types of UCL injuries. Instead of a full reconstruction, some athletes may be candidates for a UCL repair with an internal brace. This procedure involves repairing the existing ligament and reinforcing it with a collagen-coated suture tape, enhancing the ligament’s healing capacity. This newer technique has significantly shortened recovery times, with some players returning in as little as 6 to 8 months. The catch? It’s only viable for patients with good ligament quality and specific tear patterns, typically located at the top or bottom of the ligament rather than complete midsubstance tears.
Injury prevention and the future of UCL treatment
With more pitchers than ever undergoing UCL surgery, medical professionals continue to explore ways to improve both surgical outcomes and injury prevention. Workload management, proper pitching mechanics, and strength training all play vital roles in maintaining elbow health. For athletes, coaches, and parents, understanding the risks and the latest treatment options can help make informed decisions about care and rehabilitation.
Looking ahead: A new season and new medical advancements
As we embark on another exciting baseball season, it’s important to appreciate the incredible medical advancements that have kept so many of our favorite players in the game. While no one wants to see an elite arm sidelined, the silver lining is that the path to recovery is more refined than ever before. For Gerrit Cole and others facing this challenge, history has shown that a comeback is not only possible—it’s probable.
About Nikhil N. Verma, MD
As the head team physician for the Chicago White Sox, he has unique experience in treated baseball related conditions such as labrum injuries in the shoulder and ulnar collateral ligament injuries (Tommy John) in the elbow. Currently, Dr. Verma performs over 800 procedures annually and is the Director of the Division of Sports Medicine and the Sports Medicine Fellowship Program. He is a member of several professional organizations, including the American Orthopaedic Society for Sports Medicine, American Shoulder and Elbow Society, and Arthroscopy Association of North America, and is the past president of the Major League Baseball Team Physician Association.
