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Tying Up Loose Ends with Crawford

Former Red Sox outfielder Carl Crawford

Traded Red Sox outfielder recovering from Tommy John surgery

  • Date: 8/29/2012
  • BIDMC Contact: Gary Gillis

They are in vastly different lines of work, but both Dr. James Andrews and Red Sox general manager Ben Cherington were recently involved in some major reconstruction that involved Carl Crawford. Dr. Andrews performed Tommy John surgery on the outfielder's left elbow. Cherington orchestrated a nine-player deal that carved Crawford, Josh Beckett, Adrian Gonzalez and Nick Punto (along with over $250 million in salary obligation) from the Red Sox roster.

The results of Cherington's work are already on display. If sports radio and blog comments are any indication, there has already been a significant healing of psychological wounds among the fan base.

Recovery from Tommy John surgery is a lengthy process. Twelve to 18 months is the usual timeframe when you're talking about pitchers - perhaps closer to a year for a position player like Crawford. So he and his new employer, the Los Angeles Dodgers, will have to wait a good deal longer before passing judgment on the good doctor's handiwork. When it comes to elbow reconstruction, Dr. Andrews has a reputation of being not just good, but one of the best.

"For a throwing athlete this is as significant as it can get, surgically speaking," according to Dr. Joe DeAngelis, a surgeon in the Sports Medicine Division of the Department of Orthopaedics at Beth Israel Deaconess Medical Center. "Yes, James Andrews performs this procedure routinely, but there is nothing routine about it. Few things are as invasive or delicate as reconstruction of the ulnar collateral ligament."

Thirty-eight years ago, desperate pitcher Tommy John approached Dr. Frank Jobe, looking for a way to repair his torn UCL and resurrect his career. How desperate? When Dr. Jobe presented the idea of an untried surgery that involved harvesting a non-essential tendon from John's wrist, threading it through a few holes that had been drilled in his humerus and ulna (two of the three bones that meet at your elbow), and suturing it together, the pitcher essentially said, "What have I got to lose?"

Well, he never did win a Cy Young award, though he finished second in the voting twice. He won 164 games and pitched for 14 seasons after the surgery . I guess you could say that surgery was a success. That one and the many thousands like it that have been performed since. His bust may not be in Cooperstown but Tommy John is immortalized in the annals of orthopedic surgery.

"When Dr. Jobe conjured up the idea, nobody knew if it would work," Dr. DeAngelis says. "Now it's a tried and true procedure. But frankly, the surgery is just the beginning. In my opinion, the success or failure depends on the rehab."

As Dr. DeAngelis pointed out, a UCL tear is almost always the result of the wear and tear of a repetitive throwing motion. Specifically, a throwing motion that lacks good mechanics. If you don't fix the mechanics, you haven't really fixed the problem.

"Think about it. Players have reached the major league level by doing things a certain way. Now they have to change," Dr DeAngelis explains. "These guys have to break their bad habits or risk re-injury. They have to learn how to throw all over again in a way that is going to reduce the strain on their elbow. It's not always easy."

But there is plenty of incentive for a professional athlete. Anything (within the rules) that can preserve or extend the relatively brief window of opportunity to capitalize on their talent is worth exploring. Not that Crawford has to worry about that. He's got five years left on a deal that will pay him more than $20 million a season. He hopes he has a chance to earn it.

I wish him well … and so do the Dodgers.

August 2012