Tommy John surgery 'epidemic'?

So, if that trend continues, baseball could be headed for an unprecedented number of Tommy John surgery patients. But this just in: We don't know that yet.

"What you have to remember is that all these surgeries are mutually exclusive," Conte said, "because they happen to individuals. Therefore, to say, 'We could have 15 by the end of April, so we'll therefore have 40 by the end of the year,' that's not necessarily true."

But where we go from here is a subject of major interest to the sports-medicine community. Why? Because right now, the TJ spike of 2012 -- when the number of Tommy John surgeries more than doubled the previous average -- is regarded as a fluke year. But what happens if this year's total mushrooms right back to 30-plus, 40-plus or beyond?

"An epidemic is a long-standing issue," Conte said. "Not a short blip. ? So, as we appraise what's happened this year, it may be closer to 2012. And if it is, it makes 2012 maybe not an anomaly. It could be the beginning of something."

Why are more pitchers needing a second TJ surgery?

To those of us who just follow baseball orthopedics as a "hobby," it's merely the long list of names on the disabled list getting our attention. But to people who actually practice sports medicine, it's a second burgeoning trend that's arousing their curiosity -- and concern.

That would be the increasing number of pitchers who are having Tommy John surgery for a second time. Consider this:

  • In the dozen seasons from 2000 to 2011, according to Baseballheatmaps.com, an average of 15.8 major league pitchers per year had Tommy John surgery -- peaking at 20 in the 2007 season.

  • Then, in 2012, that number spiked to 36 -- only to confuse everyone by boomeranging back down to 19 in 2013.

  • From 2000 to 2013, the average number of Tommy John surgeries performed before Opening Day was only two per year. This season, there were seven -- followed by four more just in the first nine days of the season.

  • From 1996 through 2011, the total number of pitchers who needed to repeat TJs came to 18 -- in 16 years.

  • But from 2012 to 2014, we've seen 14 of those "revision" surgeries in three years -- including six just in 2014 (Medlen, Beachy, Jarrod Parker, Josh Johnson, Cory Luebke and Peter Moylan).

So, what does this mean? Even folks who study this sort of thing for a living aren't totally sure.

"It's the ones that are recurrent ? that are more of a challenge to understand," said Dr. Michael Ciccotti, the leader of MLB's elbow study group, the head team physician for the Phillies and the director of sports medicine at the Rothman Institute in Philadelphia. "And, in some ways, they're also more alarming."

The sports-medicine community is dividing these repeat TJ patients into two groups. One includes pitchers such as Brian Wilson and Joakim Soria, who had their first surgery while they were still in their teens, then needed a second operation after a long period of post-operative success.

But the second group includes pitchers such as Medlen, Beachy and Daniel Hudson, whose comebacks from TJ led to a second elbow blowout within two seasons (or, in the cases of Beachy and Hudson, basically zero seasons).

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