reports contain only bland information about nameless patients. But in the
JBJS article, we find Case I, a twenty-nine-year-old professional baseball
player. This is obviously Tommy John.
The article presents the clinical information about his initial injury,
suffered as a twelve-year-old Little League pitcher. Amazingly, Tommy
had been injected with steroids approximately twenty-five times over an
eight-year time span as a professional. After having his elbow debrided
(cleaned up) in 1972, he returned to form, and was actually having a great
1974 season, starting out 13–3. In July, while throwing a hard slider, he
felt severe pain and actually felt his elbow snap and give way. We have a
stress radiograph labeled “1974,” also obviously Tommy.
Years ago, Dr. Jobe confided to me that the groundbreaking operation
was performed with no prior practice on cadaver arms, and with no
biomechanical testing to scientifically prove its merits. This is a startling
revelation to a younger surgeon, further buttressing the notion that Dr.
Jobe was a courageous innovator.
Pioneering surgery of the hand had demonstrated the utility of
transferring a tendon from one part of the hand to another when treating
polio. Thus, a partially paralyzed leg or arm could regain function. One of
the trailblazers in this type of surgery was Dr. Jacquelin Perry, who worked
for decades at Rancho Los Amigos in metro Los Angeles, and was a
lifelong friend of Frank Jobe. It made sense to Dr. Jobe to harvest one of
these forearm tendons, the palmaris longus, which is of little functional
importance, from Tommy’s right arm to his left elbow. Amazingly, the
body senses that this newly placed tendon from another place belongs in
its new home, and quickly begins to vascularize it and bring it to life (in a
biological and biomechanical sense).
In the article there is a series of drawings that explain the revolutionary
operation, and details the surgical technique. The drill holes are
strategically placed in the humerus and the ulna, and if precisely placed
(to the millimeter) the new tendon set into the drill holes will replicate the
function of the torn ligament. The collateral ligament of the elbow is only
about an inch long, and less than the diameter of a pencil. Careful
biomechanical studies have (now) shown which part of the ulnar collateral
ligament (UCL) is important in throwers: the anterior bundle of the
anterior band of the UCL.
marcin
(Marcin)
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