When Dr. Frank Jobe invented a surgical procedure in an attempt to prolong Tommy John's career in 1974, he put the odds of John ever pitching again at one in 100.
"I did," Dr. Jobe said with a laugh in a phone interview Thursday. "But apparently that's just because I didn't know any better."
Now, 38 years later, Dr. Jobe has a bit of a different take on the odds of a pitcher not only pitching again, but returning to pre-surgery form after undergoing the elbow ligament replacement procedure that has come to be known as Tommy John surgery. And it's certainly an uplifting number for guys like Joakim Soria, Ryan Madson and John Lackey, who have all had or are set to have Tommy John surgery.
"About 94 percent," said Dr. Jobe, who along with Dr. Robert Kerlan co-founded the Kerlan-Jobe Orthopaedic Clinic in 1985.
In the past two weeks, the Royals (Soria) and Reds (Madson) both received news that their closers will miss the entire 2012 campaign to undergo the procedure. Tommy John surgery reconstructs the ulnar collateral ligament (UCL) in the elbow by using a tendon from another part of the body, most commonly the forearm or hamstring.
"You can't control any of this stuff," Madson said. "You can't plan anything. I just have to put it in God's hands and let Him take care of it. Everything will be fine. I trust that, and I will do what the trainers say. Bad luck? I don't know if you can call it that. Many guys have had this surgery and come back stronger. It's kind of a rite of passage. Hopefully, that's all it is."
Madson is certainly right about the frequency of the operation in today's game. The procedure that was once considered a longshot by its own inventor has become commonplace. Look up and down the roster of each of the 30 Major League clubs and at least one pitcher -- more likely two or three -- has had the surgery at some point in his collegiate or professional career.
Then there's a team like the Cardinals, where you're more likely to find a pitcher that has had the surgery than you are to find one who hasn't. Jaime Garcia, Jake Westbrook, Kyle McClellan and Chris Carpenter all underwent the surgery earlier in their careers before helping lead the Redbirds to a World Series title last season.
Making that feat even more impressive was the fact that the staff unexpectedly lost co-ace Adam Wainwright before the season even started when he took his turn at the surgery last February. Wainwright has allowed just three earned runs in 18 2/3 innings this spring, putting him right on track in his recovery, which takes 12-18 months for the typical pitcher.
"I remember being down here [in Spring Training] when we got that news," current Cardinals manager Mike Matheny said. "We all felt sick for him. We got the news that he was going to have to have Tommy John [surgery], and I remember somebody at that point saying, 'Well, it sets up really good. He's going to be ready to go right from the start next year.'
"And I'm thinking, 'Man, that's just kind of a bizarre way to think.' But I certainly understand it now."
The surgery has become so reliable that it allows for that glass-half-full type of thinking, but like anything else, the procedure doesn't come without flaws. After all, any time you operate on a Major League pitcher's throwing elbow, there's going to be some cause for concern, especially for a younger pitcher on the verge of making it in the big leagues like Dodgers right-hander Rubby De La Rosa.
"I've never had surgery of any kind," said the 23-year-old De La Rosa, who underwent Tommy John surgery last August, little more than two months after making his Major League debut. "I fear a little bit about coming back, but I have to come back. I'm confident I can come back and pitch again."
If De La Rosa needs any sort of reassurance that he can indeed return from the procedure and continue his pursuit of big league success, he doesn't need to look very far. Chris Capuano, who signed a two-year contract with the Dodgers this offseason and is set to enter the season as the club's fifth starter (a spot left void in part because of De La Rosa's absence), has undergone Tommy John surgery -- twice.
After having the surgery in 2002, prior to breaking into the Majors, Capuano found himself on the operating table for round two of Tommy John surgery in '08. Last season, Capuano turned in 186 innings of work in an injury-free 31 starts for the Mets. Capuano's case also provides hope for one of the other recent Tommy John patients, as this will also mark the second Tommy John surgery for Soria.
"When you have to have it the second time, you do worry about it a little bit more," Dr. Jobe said. "You might be someone whose connective tissue is not quite as quality as the other guys who have gotten it just once and had it hold up. The other thing is he might have gone back to pitching too soon, but I'm not sure if that's the problem in [Capuano's] specific case."
Therein lies the key -- how soon is too soon?
In Dr. Jobe's mind, the rehab process and allotted recovery time is just as -- if not more -- important than the surgery itself. The Nationals, for one, are buying into that concept as they continue to carefully work Stephen Strasburg, the club's 23-year-old ace, back from his September 2010 surgery.
Now, more than 18 months removed from the surgery and with five September starts last season and five more this spring under his belt, Strasburg is ready to completely put the surgery behind him.
"My mind is a lot clearer. I just go out there and throw the baseball," Strasburg said. "I don't think as much about mechanics or anything. I don't feel myself holding back a little bit.
"I think it was more on the mental side. Not necessarily bracing for it -- but just that little thing in the back of your head when you are throwing a pitch. It's like, 'Is everything right?' Now, there are no second thoughts at all in my head. It feels more natural now than it did coming right off surgery."
Said Jobe: "I think once he's back and has rehabbed it properly and has had that good surgery with a good piece of tissue, he's as good or better than before."
That's not to say the surgery itself makes a pitcher better, though. Sure, Dr. Jobe has heard the stories about guys throwing harder after the surgery than they had before it, but he says that's not simply a result of having a reconstructed ulnar collateral ligament.
"So many fathers that have sons come to the office and say, 'I want to have that Tommy John surgery now before he gets hurt,' but that's not how it works," Dr. Jobe said. "The surgery doesn't automatically make him better, as much as the rehab does. If you don't have a good rehab to make that tissue come back with good blood supply, then you're not as well off.
"You've got to have both. The surgery puts it in place; the rehab makes it strong again. It's a whole process."
To be fair, there are guys who have undergone the surgery and never been the same again -- and not in a good way.
Kris Benson missed the 2001 season after having the surgery, and while he went on to pitch seven more seasons, he never matched the strikeout or ERA totals from either of his first two Major League seasons prior to the surgery. Former Astros pitcher Brandon Backe had the surgery in September '06 and, in his first full season back on the mound, went 9-14 with a 6.05 ERA and served up a Major League-worst 36 home runs in '08. He posted a 10.38 ERA in five appearances before being released by the club in 2009 and hasn't pitched in the Majors since.
The good news is that the process, if followed methodically, has proven countless times to be a successful one. Former reliever Eric Gagne had the procedure done before even breaking into the Major Leagues, but then went on to win the 2003 National League Cy Young Award in the midst of converting a Major League-record 84 consecutive save opportunities. Carpenter had his surgery done in '07 and, just more than three years later, led the Cardinals to a Game 7 victory in last year's Fall Classic, capping off a postseason run in which the right-hander went 4-0.
The list of feel-good stories, which also includes the likes of John Smoltz, A.J. Burnett and Kerry Wood, all started back in 1974 with John himself. And while Dr. Jobe enjoyed watching John extend his career another 14 years after the surgery, notching 164 wins during that time, he also has a soft spot for each and every pitcher whose career is saved by the cutting-edge surgery he designed nearly 40 years ago.
"I do, it really makes me happy," Dr. Jobe said. "Sometimes it just makes you want to cry watching those guys go on to great things. It really does."