Have widely publicized surgical-treatment successes in the professional athlete community been a help or hindrance to youth athletics?

Expectations too high

Young patients’ parents frequently think their child is like an NFL player or a professional athlete — they are not. They a regular kids. They need to have some fun, learn to be team players, all of those things are more important than just being very good. Prevention and stopping the injury are more important.

[Tommy John surgery] is overdone. Many of them do not succeed. You do not see the ones that do not come back. They see some player use [platelet-rich plasma treatments (PRP)] and go back to playing in a few weeks, and they think everybody else is the same way. A good example is a torn ACL — a professional player comes back and plays; now all the kids want to come back in six months, which is impossible.

Professional athletes have much more support, and they are probably in much better shape. They have trainers they work with every day, they work out every day. High school and college athletes do not have time to do that. So, all of these operations — PRP and such — all of the young athletes want to use it. Their expectations are too high.

Professional athletes’ injuries and recoveries have little to do with the injuries that we see every day. Professional athletes who “make it” do not have many injuries in high school. If they had injuries, they would not be there. And when a professional gets hurt, they have much more help. We mentioned Tommy John — it is just like that. “I want to be Tommy John.” What about the players who did not come back?

It is dangerous in the sense that the expectations are too high and there is too much disappointment. I always tell the athletes they have many things to do in life other than athletics. You can have some fun. And when they hurt themselves more than once, I tell them maybe it is time to think of something else to do. The point is, you have a lot of life to go. Injuries can give you a perspective on life and show you that you have more important things to do in the long run.

Many injuries occur because of poor technique, overuse, poor coaching or conditioning. Some of those can be prevented. Hopefully, if we do more work for prevention, we do not need to come to treatment. Treatment is improving and we are learning how to do it better, but there is no surgery or treatment that can be guaranteed to be 100% successful. Treatment is good, but we need to do more in terms of prevention.

Freddie H. Fu, MD, is the David Silver Professor and Chairman at the University of Pittsburgh Division of Sports Medicine.

Certain surgeries overdone

There is clearly a perception by parents and coaches that if [Tommy John surgery] is performed, the athlete will return to — and possibly exceed — his pre-injury status. Overall, there are probably too many of these procedures being performed.

In my mind, the clear-cut indication is the player who has a single, specific, macrotraumatic event. Many athletes will have a “toggle” on valgus laxity evaluation, possible abnormalities on MRI and/or stress radiographs, but in my opinion, these are not absolute indications for reconstruction. We have noted in the White Sox organization that many athletes who have recovered from Tommy John surgery will, within two years of UCL reconstruction, require shoulder surgery. This is suggestive that abnormal mechanics play an important role in both elbow and shoulder conditions in the overhead throwing athlete.

It is surprising how often we detect abnormalities — tight hamstrings, core weakness, scapular dyskinesia, posterior shoulder tightness — in addition to observed throwing mechanics that may place the elbow at risk. Our goal with the STOP campaign is to “keep athletes out of the OR and on the playing field.” The emphasis on pitch counts, avoiding year-round play, avoiding overlap between house, travel leagues and showcase tournaments, cross training and proper mechanics are all efforts to reduce these significant injuries that are being seen in epidemic proportions.

If a high school athlete requires UCL reconstruction, the statistical likelihood of advancing to an elite level such as professional baseball is exceedingly low. All of us in sports medicine who care for adolescent athletes have seen the “stud” 13- or 14-year-old pitcher who injures the elbow throwing too often, too many pitches, throwing curves too prematurely. There is a relative graveyard of injured elbows out there.

We need to continue to educate coaches and parents about overuse injuries. I think it is important to educate these adults that once the elbow is seriously injured — no matter how good our reconstructions may be — the elbow will not be normal.

Bernard R. Bach Jr., MD, is the Director of Sports Medicine of Midwest Orthopaedics at Rush.