For decades, “Tommy John surgery” — ulnar collateral ligament (UCL) reconstruction — has been one of sports medicine’s greatest success stories. Most pitchers make it back to the mound.

But as data and the game itself evolve, one thing is clear: returning to play is not enough.

The Old Standard: Just Getting Back

For years, success was defined by a simple question — did the player return to sport? Early on, that was enough. Throwing again at the professional level after an elbow reconstruction was groundbreaking.

Now, with advances in analytics and performance tracking, we know that returning to sport doesn’t mean returning to performance.

The Evidence: The Gap Between Play and Performance

Recent studies have redefined expectations.

• Fury et al. (2021, Orthopaedic Journal of Sports Medicine) found that while many MLB pitchers came back after UCL reconstruction, their workloads declined — fewer innings, fewer pitches — and subtle dips in performance persisted. Pitchers came back different, and not necessarily better.

• A 2025 study in the American Journal of Sports Medicine by Dr. Chris Ahmad and colleagues reported that fewer than 30% of pitchers returned to full performance, as measured by advanced analytics, by three years post-surgery. Even those who did return often performed below their pre-injury level.

These findings challenge the idea that surgical success equals athletic success. The bar has moved higher — and so must our methods.

The Game Keeps Moving

While an athlete spends 12–24 months rehabbing, baseball keeps changing around them.

• Average fastball velocities rise every season.

• Pitch design becomes more advanced.

• Hitters, their training, and competitive analytics evolve.

By the time a player returns, the league standard has shifted. Simply reaching their old numbers isn’t enough — it means they’ve fallen behind.

Today’s athletes aren’t trying to get back to where they were; they’re striving to be better. Innovation in surgery and recovery is how we help them meet that expectation.

What Innovation Looks Like

Innovation in UCL surgery isn’t just about better sutures or grafts — it’s about improving the entire process:

• Advanced surgical techniques: Surgical treatment tailored to unique injury characteristics.

• Objectively-driven, performance-based rehab: Integrating velocity, wearables, strength progressions into individualized programs.

• Training and monitoring: Intentional techniques to train the key stabilizing muscles that protect the UCL while also monitoring both global and specific markers of readiness.

This integrated approach turns recovery into an opportunity — not just a repair.

Redefining Success

The future standard for UCL surgery should be return to performance, not merely return to play. It’s about restoring capability, confidence, command, and competitive edge.

Innovation is how we get there. It’s why we lay our head down on the pillow each night dreaming of ways to get better. This is how we ensure that our pitchers return ready for the game as it is — and as it’s becoming.

References

• Fury MS et al. Return to Performance After Ulnar Collateral Ligament Reconstruction in Major League Baseball Pitchers. Orthop J Sports Med. 2021.

• Mastroianni MA, Ahmad CS et al. Return to Performance After Ulnar Collateral Ligament Surgery in Major League Baseball Pitchers. Am J Sports Med. 2025.