Frank Jobe, M. D: Baseball's medical revolutionary

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Frank W. Jobe, M.D.

 

There are currently 366 pitchers among all players on active 40-man rosters in Major League Baseball. If it weren't for Dr. Frank Jobe, the number of pitchers on MLB rosters would be reduced by roughly 25 percent.

 

The orthopedic surgeon and former Los Angeles Dodgers team physician conceived of the revolutionary procedure, now known as Tommy John surgery, that restores function to a thrower's elbow after the failure of a critical ligament. Named after his first patient, the surgery is now routine in the world of baseball medicine and has clearly prolonged the careers of numerous pitchers worldwide. For that reason, Jobe received special recognition for his contributions to baseball at the National Baseball Hall of Fame awards presentation in Cooperstown, N.Y., on Saturday.

 

"When you consider that almost one in four active pitchers in Major League Baseball have had a Tommy John operation, I don't think there is anyone who has changed the landscape of a sport more than Frank Jobe has for baseball," said Dr. Neal ElAttrache, a longtime partner of Jobe's at the Kerlan-Jobe Orthopaedic Clinic in Los Angeles and his successor as Dodgers team physician.

 

During the Hall of Fame presentation, Jobe was joined on the stage at Doubleday Field by John, his patient and friend. At the evening receptions, Jobe was surrounded by family, including his wife, Beverly, along with their children and grandchildren. Hall of Fame legends introduced themselves to him, congratulating him and thanking him for all he has done for baseball.

 

Generations of surgeons who trained under Jobe, along with other sports medicine colleagues and research collaborators, traveled from around the world to show their admiration for a man whose influence, they believe, transcended the realm of sports medicine into simply the realm of sports. Among them were team physicians for professional and college baseball, football and basketball organizations along with others who treat recreational, high school and youth athletes.

 

Dr. Teruhisa Mihata, a shoulder and elbow surgeon who also conducts biomechanical studies, traveled from Osaka, Japan, to honor the mentor he has studied with for 10 years in the States. Even former Dodgers pitcher Chan Ho Park was present to see his former team physician recognized.

 

The gathering of Jobe supporters in Cooperstown was a reflection of how many he has touched in the worlds of sports and medicine. Considering the term "sports medicine" was just coming into use around the time of John's 1974 surgery, the trajectory of Jobe's now-famous procedure has followed that of modern sports medicine; remote concepts once associated only with elite athletes are now increasingly familiar to athletes of all ages and skill levels.

 

The surgery's origin

In 1974, John thought his days on the mound were over. In a game against the Montreal Expos on July 17, with runners at first and second and Hal Breeden at the plate, John threw a pitch that landed nowhere near the plate. John said of that moment: "I felt a pain I've never had before."

 

Jobe saw the pitch sail and John in pain. He examined John in the clubhouse immediately afterward and saw something alarming.

 

"I could open his elbow up to a 45-degree angle, and I figured the [ulnar collateral ligament] was gone," Jobe said. "At the time, they called the injury 'throwing the elbow out' and guys were sent home. And they didn't return."

 

In that era, if a serious injury threatened a pitcher's throwing elbow, he was likely replaced the following season. As John said, "You were toast after surgeries." Disappearing into the sunset with broken bodies and busted dreams, not able to see their careers play out the way they had envisioned, they could only watch as the next pitching prospects would come along to take their spot. Sadly, many felt they still had more baseball in them. They weren't old men yet, even by athletic standards, but their inability to consistently control the ball's location or velocity left them no opportunity for pitching. Most accepted their fate and yielded to the hand their bodies had been dealt.

 

Tommy John was not so accepting. At first, Jobe tried casting the elbow for eight weeks, hoping for scar tissue to fill in and allow John to throw. John could throw, but only at about 75 percent of normal. He tried to forcibly pitch through the pain, but the arm simply wouldn't cooperate. He turned to Jobe, who initially told him there was nothing more he could do. John responded by telling Jobe he did not want his career to end. He did not want to be sent home. He said, "Doc, you've got to come up with something."

 

Jobe thought about it and wondered if he could tap into what his colleague Dr. Herb Stark, a hand surgeon, was doing with tendon transfers to restore finger function to his patients. Stark would harvest a tendon from the patient's forearm and move it to the hand. Jobe wondered if he couldn't harvest the same tendon and put it where the failed ligament used to be to restore stability to the elbow.

 

[+] EnlargeTommy John

Focus On Sport/Getty Images

Tommy John won 288 major league games, 164 of the wins coming after he had the surgery that bears his name.

He offered it to John as an option but cautioned him against expecting much: "I told him it was only about a 1-in-100 chance it would work."

 

But John's response was optimistic: "I told him a 1-in-100 chance is better than no chance at all. And without the surgery, I've got no chance."

 

As scary as it might seem to undergo a procedure never before attempted, John was not as nervous as he had been a couple of years earlier. In 1972, John had his first elbow surgery and feared he would never regain his form. He underwent a procedure with Dr. Jobe to remove bone chips and repair the flexor mass, the muscle group that bends the wrist and helps control grip.

 

The procedure was a success, and John returned to pitch in 1973. But John lacked confidence in his elbow, something he realized during spring training after he had an embarrassing tirade in response to frequent questions about his health. Jobe came to John's rescue with some simple advice.

 

"He told me, 'I can tell you your elbow is healed; there's nothing physically wrong. But that's all I can do. No one can convince you your elbow is sound but you,'" John said. "And then it clicked. I began to throw fine the next day and I never looked back."

 

That experience gave John not only confidence in his elbow, but also confidence in his surgeon. He needed both in 1974 when he agreed to undergo the first surgery of its kind, a reconstruction of the ulnar collateral ligament using a palmaris longus tendon graft.

 

On Sept. 25, 1974, Jobe performed the very first Tommy John surgery.

 

Then came the waiting. As he started to regain his motion after surgery, John noticed that something wasn't right. He was developing a claw hand as the fourth and fifth fingers began to curl downward, and he was experiencing numbness in those fingers. He also noticed weakness in his hand and couldn't hold a baseball properly to throw it. Perhaps the surgery wasn't going to work after all.

 

John didn't give up. He described what he felt to Dr. Jobe, who already suspected the ulnar nerve as the culprit. This is where John helped Jobe figure out the next step. John noticed if he straightened his arm outward, the symptoms relented. But as soon as he flexed his elbow, they worsened again. Jobe recognized the nerve was being restricted in certain positions. He explained to John that he would have to go into the elbow again to remove scar tissue from the area around the nerve.

 

Back they went into surgery, hoping this would be the final hurdle. Jobe freed up the nerve from adjacent scar tissue and transposed it to a slightly more forward location, where it would be less likely to be compromised. And it worked. The feeling returned to John's fingers, the strength came back to his hand and the claw went away. Now if he could just get back to the mound.

 

John and the Dodgers' athletic trainer worked diligently on a program with that goal in mind. John started by playing catch; he threw a little bit every day, checking in with Dr. Jobe regularly about what he had tried in practice, what he felt and whether it was easy or difficult. And Jobe would allow him to progress based on how his symptoms behaved. This would ultimately become the foundation for the rehab program following Tommy John surgery that exists today.

 

The ultimate test came one year and one day later, when John took the mound in a major league game. While Jobe had seen him throw throughout the course of rehab, this was different. While he wasn't nervous during either surgery, Jobe said he had "sweaty palm syndrome" watching John pitch.

 

"I had no idea if it would hold. I thought it might just snap off," he said.

 

Then came the first pitch. For starters, the ball went where it was supposed to go. And better yet, John didn't seem to be in pain. With each pitch, Jobe could relax a little more. It appeared as if the surgery just might hold up.

 

And did it ever! For 14 years after undergoing Tommy John surgery, the pitcher never missed a start. John won more games after surgery (164) than he did before (124). When he retired from the game, it wasn't because of his elbow. Yes, the surgery had worked.

 

http://espn.go.com/mlb/hof13/story/_/id/9519377/an-appreciation-dr-frank-jobe

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