This news story describes a study performed at one of the most famous sports medicine clinics in the U.S., where one of the most famous elbow surgeons in the world (and his colleagues) performs an operation known as “Tommy John” surgery (named for the Hall-Fame pitcher). The study shows that more young athletes are getting elbow reconstruction surgery at this clinic than ever before. The news story’s sole source—an author of the study—suggests that this is a widespread epidemic and speculates that the reason for the increasing number of operations in young athlete is that they are over-using their immature elbows during year-round play without any breaks. Although this may be true, the article provides no research to support this assertion. The reported increase in elbow reconstructions among young athletes may be a serious problem worthy of concern, or it may be a statistical quirk. It’s possible, for example, that this clinic is more likely than less-famous clinics to attract the parents of young athletes with a career-threatening injury. Until there is similar evidence of high surgery rates from more clinics and solid evidence that these operations are caused by over-training, this article could be raising unfounded alarm.
The news story provides insufficient information in other areas as well. There is no mention of costs, potential harms, or treatment options other than surgery. And the story cites no source who is independent of the research under consideration.
Interestingly, the researcher interviewed for the story assigns blame for over-training injuries to the athletes (and perhaps by implication parents and coaches). Another source might have pointed out that sports medicine physicians sometimes wonder whether they too contribute to recurrent or chronic injuries, by helping athletes to return prematurely to the sports that cause them harm.
The article doesn’t mention the cost of surgery.
The article says the absolute rate of success (return to previous level of competition or higher) was 83% in a cohort of 743 people who had elbow reconstructive surgery, a rate similar to other studies. (Am J Sports Med. 2008;36(6):1193-205.) However, the news article does not point out that this success rate varied a good bit, and was as low as 56% in minor league pitchers.
The news story says nothing about the harms of treatment. A press release describing the unpublished study said 10% of patients had complications. A recent review reported similar complication rates, though damage to the ulnar nerve occurred in anywhere from 3% to 20% of cases. (Am J Sports Med. 2008;36(6):1193-205.) Though most people appear to do well, sometimes elbows are worse off after the surgery than before.
The article fails to explain that it can be difficult to draw broad conclusions on the basis of a single-center cohort study such as the one it describes. See “Disease Mongering” above.
The news story describes a study performed at one of the most famous sports medicine clinics in the U.S., where one of the most famous elbow surgeons in the world operates. The reported increase in elbow reconstructions among young athletes may be a serious problem worthy of concern, or it may be a statistical quirk. It’s quite possible that such a clinic is more likely than less-famous clinics to attract the parents of young athletes with a career-threatening injury. If so, the premise of the news story—that year-round over-training is driving more kids to surgery at a younger age than ever before—might not be true. The article provides no evidence of over-training to support this contention. Until there is similar evidence of high surgery rates from more clinics and solid evidence that these operations are caused by over-training, this article could be overstating the prevalence of the condition, and thus contributing to disease mongering.
The news story failed to quote any source other than the author of the study it describes, and cited no independent source.
The news story mentions only surgery as a treatment for the laxity and pain caused by an injured ulnar collateral ligament. Most experts advise prolonged rehabilitation and physical therapy as the first-line therapy, since the surgery is difficult to perform and the recovery time is very long, typically a year or more.
According to the article, “Tommy John” surgery to reconstruct the elbow’s ulnar collateral ligament is perhaps too-widely available.
The article provides nice background on the history of the surgical procedure, pointing out that it has been around since the 1970s.
The story does not appear to rely solely or largely on a news release, though it mirrors some phrasing from a press release issued by the clinic that performed the study.