Survey finds misconceptions about Tommy John surgery among players, parents, coaches

SAN DIEGO — A survey of players, coaches and parents has revealed a trend of misguided perceptions regarding ulnar collateral ligament injury, according to findings presented by R. Michael Greiwe, MD, here at the 2011 American Orthopaedic Society for Sports Medicine Specialty Day.

“In summary, players of all ages, coaches and parents all have misconceptions regarding ulnar collateral ligament reconstruction,” Greiwe said during his presentation. “These are important issues … we must do a better job education the public regarding ulnar collateral ligament reconstruction.”

The results of the survey provide the first clinical evidence of widespread misconceptions regarding injury to the ulnar collateral ligament (UCL) and its reconstruction, otherwise known as Tommy John surgery, Greiwe said.

Injured players returning to play, media coverage and the overall desire to improve athletically are all driving forces behind the growth of Tommy John surgery and related misconceptions, he said.

“Tommy John surgery is really on the rise,” Greiwe said. “Why is this? Increasing demands on younger players [and] improved techniques in surgery with decreased morbidity. It is certainly being widely performed.”

Coaches, parents and players

Greiwe’s group developed a questionnaire that measured perception of Tommy John surgery in terms of indications, operative technique, risks, recovery time and overall benefits. They surveyed parents, coaches and players — from the youth league to the college level — online and through one-on-one interviews. The survey was completed by 65 players, 14 coaches and 14 parents.

Although evidence indicates that high pitch counts and early development of breaking pitches contribute to UCL injuries, Greiwe reported that 35% of coaches, 30% of players and 29% of parents surveyed did not believe that the number of pitches a player threw was a risk factor.

The survey also revealed that 29% of players included shoulder ligament injury as an indication for Tommy John surgery. Fourteen percent said shoulder arthritis was an indication for the procedure. According to the study, 35% of coaches considered shoulder ligament injury a surgical indication and 7% considered shoulder arthritis an indication.

Further misconceptions

Greiwe noted that although there is little in the literature to support the notion that performance, control and velocity could be improved over pre-injury form through Tommy John surgery, his survey found that around 69% of players and 79% of coaches believed this to be the case.

Return to play was underestimated by those who took the survey, Greiwe noted. Fifty percent of coaches, 40% of players, and 31% of parents estimated that return to play after Tommy John surgery would take less than 9 months.

Reference:
Greiwe RM, et al. Perceptions of Tommy John surgery. Paper 9693. Presented at the 2011 American Orthopaedic Society for Sports Medicine Specialty Day. Feb. 19, 2011. San Diego.
Disclosure: The authors of the study have reported no relevant financial disclosures.

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