I am sitting in the executive office suite at Arthrex in Naples, Florida, waiting to meet with company founder and president, Reinhold Schmieding. Today is a very busy day for Reinhold, with hundreds of young surgeons in attendance for the annual resident symposium, and his impending trip to Munich, Germany, where he spends every summer, overseeing the European branch of Arthrex. Despite all of the commotion, the American-born son of German-American dentists has agreed to the unthinkable: a sit-down interview. Quite possibly, it’s only because I am a busy shoulder and elbow surgeon with the proper pedigree of having trained at the famous Kerlan-Jobe Orthopedic Clinic in Los Angeles, but whatever his reasons for allowing me to pepper him with questions, I am pleased to sit down with one of the world’s great entrepreneurs.
As I review my research papers while seated on a modern, black leather chair, I glance down at a simple white table with tubed, aluminum alloy A-frame legs, and a thought occurs to me: is this the drafting board of legend, where Reinhold Schmieding designed the Arthrex logo that has endured almost forty years? While living in a small apartment in the Olympic Village in Munich in 1981, the twenty-six-year-old simultaneously invented his company’s name and logo while perched over a $50 drafting table purchased at a home improvement store, and the thought of a “small beginnings” nostalgia is appealing to me.
Reinhold Schmieding is sixty now, still very fit and impressively energetic. After a few moments in his presence a visitor realizes his pride of ownership of Arthrex, which is now the world’s most successful sports medicine implant company, and you realize that his fierce competitiveness and loyalty are shared among all his employees. The company got its start at the very beginning of the development of arthroscopy, and Schmieding’s “better mousetrap” surgical instruments gave his empire firm footing.
As a surgeon, I’ve implanted literally thousands and thousands of Arthrex sutures, suture anchors, screws, and various other devices, and I am well aware of how Arthrex has changed the face of sports medicine around the world. But I am here to learn more about its founder and how he has achieved so much in one lifetime.
I have come to Naples armed with a few observations, and I am eager to learn how Reinhold persevered and has landed himself on the Forbes 400, poised to become one of the richest one hundred people in America.1
My first question: is this the selfsame drafting table? Yes, he confirms with a warm smile. (As I have gotten to know him better, it’s not a surprise he still has the table. He’s an interesting mix of thriftiness and extravagance, measured analysis and gut instinct.) I think the table is a talisman of sorts that memorializes simple origins and the power of self-invention.
Just as the light-powered arthroscope was becoming practical after years of development by Masaki Watanabe in Japan, surgeons in North America and Europe turned from merely peering into a joint to performing work in a joint. Watanabe’s mentor in Tokyo had initiated the development of a tool, a pencil-slim metal gadget with an ocular opening that allowed surgeons to squint into the eyepiece while bent over, face close to the operative joint. The first model was created in 1931, and subsequent models were sequentially numbered. On the twenty-first attempt, in 1958, Watanabe delivered the model upon which all subsequent arthroscopic lenses were designed. The “Watanabe No. 21” was still powered by a tiny incandescent light and had to be held to the surgeon’s face, but it led the revolution in minimally invasive surgery around the globe. Over the next two decades, arthroscopy turned from a novelty to a powerful tool, particularly with the application of a flexible, fiber optic light source and the attachment of a small video camera to the lens. No longer was the surgeon consigned to bending over and banging (and contaminating) the lens against his eyeball.
By 1981, surgeons were relieved to be standing up, manipulating the camera with their hands, and miraculously investigating the miniature world of any joint in the body. The quandary was the lack of tools to reliably accomplish anything while looking.
Enter Reinhold Schmieding and Arthrex.
Although Reinhold was born and raised in Michigan (graduating from Michigan State in 1976), he relocated to the Black Forest region of Germany to become an international manager for the US-based orthopedics company, Richards. After three years of selling orthopedic implants to surgeons in and around Germany, he became fascinated with the new developments in the field of arthroscopic surgery. While viewing the inside of the knee arthroscopically was becoming more commonplace, there was a glaring lack of dependable instruments to manipulate the tissues; namely, to grasp, cut away, and remove pieces of cartilage, bone, and meniscus. Fortunately, for the budding entrepreneur, he was stationed in southwestern Germany, long a home to the finest craftsmen in the world for the manufacturing of surgical instruments. Sensing an opportunity, Reinhold began designing and developing instruments for minimally invasive surgery, and within months, decided to leave Richards and form his own company. Naming his new enterprise “Arthroscopy Excision Instruments,” shortened to “Arthrex,” he sat at his economical drafting table and sketched out the Arthrex logo, still used today for the company that is worth billions.
Arthrex struggled to survive in its opening years, much as Medtronic had in the late 1950s. Cash flow problems, travel costs, surgeon resistance, and initial limited product offerings had Arthrex on life support. A few key early surgeons ordered surgical instruments and provided cash, just as the breakthrough guide for arthroscopic ACL reconstruction was designed by Schmieding. With Arthrex in its infancy, Reinhold Schmieding traveled to Zurich, Switzerland to exhibit his small set of knee instruments to a highly-regarded surgeon. After scrutinizing the tools, he turned to the young upstart, and questioned, “Herr Schmieding, davon wollen Sie leben?”2 He was asking, “You want to live from this?” The small set of instruments didn’t seem like an empire in its infancy.
As has been documented numerous times in this book, most of the great pioneers in medicine and surgery had great facility with their hands and an unquenchable urge to tinker with gadgets and machines. Reinhold Schmieding loved art as a child, and sensed, even in his early school years, that he processed and thought about things differently than his peers.
Sitting in front of the drafting table, I ask him for an example.
“A really important day for me was in high school, when my history teacher gave us an assignment. Placing a candle in front of us, he asked us to describe it with one word descriptions, giving us only five minutes to come up with as many words as possible. The words just kept coming to me, and I was writing them as fast as I could. When the time was up, my classmates revealed that they had come up with 15, 20, or 25 words. The teacher looked at me, and I told him 225 words. That’s when I realized I have a different way of thinking about things.”3
This example of “ideaphoria,” or the high flow of ideas, is characteristic of the creative problem-solvers in all branches of business and medicine. Combined with Schmieding’s advanced spatial reasoning and artistic bent, Arthrex has been on the cutting edge of surgeon education from its inception. Because Arthrex was born at the advent of arthroscopy, practicing surgeons had not been trained in arthroscopy during their residencies. What was needed was a company that could provide practical teaching to surgeons who were reluctant to look awkward with the completely new technology in their hands.
What may not be obvious to the lay-reader is that arthroscopic surgery is a wholly different set of technical skills, with angled mirrors on the end of lenses that tilt the perspective on the television screen. It’s like backing up a car using the rearview camera on your dashboard the first time—things work in reverse, and a lifetime of using your eyes is of no use. In time, we all become accustomed to using the technology, but no proud surgeon wants to look like a fool, or worse, put their patient at risk, while conquering a new skill.
Arthrex, while still a young company, began hosting skills labs and producing artwork that was vastly superior to its competitors. When I was a sports medicine fellow in Los Angeles in 2002, I was gifted an entire collection of animated surgical DVDs from Arthrex, years before any other orthopedic implant company could try and match them. The artwork has always come at great expense, but directly stems from Reinhold’s artistic sensibilities, and in my estimation, has paid great dividends for our patients. It also has been a great business decision, and I have always been mystified when other surgical companies skimp on their educational budgets. Reinhold tells me, “What made it necessary is what made it great.”
Arthrex survived its first decade with home offices in Munich and eventually a world headquarters in Naples, Florida. More than twelve years after its founding, Arthrex began producing its first medical implant, the specialized titanium “interference” screw used in knee ACL reconstruction. This ushered in a tsunami of implants since 1993, and in the last twenty-five years a dazzling lineup of implants for every joint in the human body has been developed by Arthrex. Rotator cuff repairs, ACL reconstructions, shoulder stabilizations, fracture management, ankle ligament repairs, and over ten thousand other implants and techniques are all addressed with Arthrex devices.
So dominant is Arthrex’s place in the sports medicine world, it has become obvious to me that it is now impossible to turn on any NFL, NBA, MLB, or NHL game and not see an athlete who has an Arthrex implant in his body. I ask Reinhold how he feels about this, and he tells me, “I feel really lucky that I came along when I did. It is obvious to me that I was perfectly prepared for this, for the founding and nurturing of Arthrex. I enjoy strategy, leadership, service, and medicine … and when presented with a challenge, can rapidly see the solutions in my head. (In the early days) when we struggled, it was my sense of survival and tenacity that kept us afloat, and I am humbled more than ever to work hard to help surgeons treat their patients better.”
I am eager to tell Reinhold Schmieding my big observation, based on years of analysis and calculations. While there are medical companies with higher annual revenues, like General Electric’s healthcare division (which does not develop implantable devices), most medical implant companies build revenue through costly, big ticket items like total hip implants and pacemakers. Additionally, among all of the largest orthopedic implant companies, the reigning CEOs have been at the helm less than five years. There is no other major medical device company that is privately held, and certainly not by the founder of a company that is almost forty years old.
Because Arthrex has so many thousands of implants, almost all of which are permanent, and not degradable, and due to Schmieding’s unprecedented tenure, including the last twenty-five years of incredibly high-volume implant manufacturing, there is one stunning conclusion. There is not another individual on earth who has personally overseen the design, manufacturing, and distribution of so many medical devices that exist in the bodies of our fellow earthlings. With Arthrex’s distribution in 150 countries, there is probably nowhere on our planet that Reinhold can go without bumping into a person who has some type of Arthrex implant in her body. In this book about the implant revolution, there is one man who has physically touched the lives of more of his fellow men and women than any other, and it seems that Reinhold Schmieding is just getting started.
On a chilly, overcast day4 the last Saturday of November 1888, the Yale squad is struggling to defeat Princeton to preserve a perfect record. The Yale Bulldogs football team has arrived at the Polo Grounds in New York City, having won the previous twelve games by an average of fifty-seven points, having not allowed a single score all year. The roster includes William Heffelfinger (who will eventually become the first professional football player) and Amos Alonzo Stagg, who will go on to become a legendary coach in multiple sports.
Walter Camp is standing on the sidelines, but he doesn’t know that history will regard him as the Father of American Football, or that he’s watching one of the most dominant teams of all time. Like any coach, all Camp cares about in this moment is the game before him. Football is not even two decades old, but it is clearly different from the game that preceded it—rugby. Many of the sport’s early changes are Camp’s, including the line of scrimmage, the position of quarterback, and the system of downs.
Determined to achieve a perfect 13–0 season, the game is uncomfortably close. Although Yale has waltzed through every match this year, this tilt against Princeton is savagery among gentlemen. In fact, the Harvard graduates who are officiating the game kick Hector Cowan, the Princeton captain, out of the game for rough play.5 They consider it good fortune to win 10–0, and retreat to New Haven as the mythical national champions.
Now, put yourself in Walter Camp’s shoes: what if someone had been seriously injured? Would you rely on a team physician to examine one of the young seminarians and diagnose a critical injury?
Of course, in 1888 there was no team physician. What many in the crowd may not have known is that a few years earlier, in 1882, Walter Camp had been just two classes short of graduating from Yale Medical School when he dropped out. Camp would later note in a biographical questionnaire “the death of a surgeon with whom I had expected to practice medicine caused me to leave the medical school and go into business.”6 He had earned his bachelor’s degree from Yale College in 1880, and then continued at the Medical School in New Haven while playing for the football team, acting as the team captain.
Another setback had occurred in 1882: Camp injured his knee in practice, thus ending his playing career. Camp had likely suffered an ACL or meniscus tear, and in the late 19th century, there was not a single operation for any type of sports knee injury. Even a relatively minor knee injury resulted in the termination of an active life.
In the Cro-Magnon days of collegiate football, injuries were common and deaths occurred with shocking regularity, and by 1905, some Ivy League schools suspended their football operations. That same year, eighteen college students died and there were 149 serious accidents.7 President Roosevelt himself summoned Walter Camp and representatives from Harvard and Princeton to the White House to respond to demands for the abolition of football in America.8 Within a year, the Intercollegiate Athletic Association of the United States (forerunner to the NCAA) was formed, with Walter Camp at the helm of the rules committee.
The Yale-Princeton game was 125 years ago. What medical technology was at Mr. Camp’s disposal?
Nothing.
Prior to our modern age, sports medicine just a century ago almost exactly mirrored gladiatorial times, with sophistication no better than an emphasis on eating meat, taking a cold bath after a competition, and have a rubdown in the training room. It shouldn’t be too surprising that eighteen college students died in 1905 while playing a violent, largely unregulated sport with essentially no advanced medical treatment available.
When a player suffered an open (“compound”) ankle fracture, he faced a potential death sentence. In the Franco-Prussian War the mortality rate of a lower leg fracture was 50 percent; in World War I, the mortality rate for an open femur fracture was a startling 80 percent. Nobody worried that Joe Theismann might die on that fateful Monday night game in 1985, nor did any viewer contemplate Ed McCaffrey’s mortality when he suffered a similar open tibia fracture in a game broadcast on Monday Night Football September 10, 2001 (just hours before the 9/11 terror attacks).
Following the first public demonstration of surgical anesthesia in the Ether Dome at Massachusetts General Hospital in 1846, Koch’s experiments to prove that bacteria were real, and the development of antisepsis by Lister, surgery became vastly safer. Coupled with the introduction of antibiotics during World War II, and the transition of medicine from a merely observational science to an investigational one, sports medicine was finally able to alter the lives of athletes.
Los Angeles was doubling in size every decade for a century up till the 1950s. As transcontinental travel was becoming more practical, the Cleveland Rams shockingly celebrated their 1946 NFL championship by moving to Los Angeles, the first move west by any major sports team. Waiting for the Rams was a gregarious orthopedic surgeon with a tragic medical secret.
Robert Kerlan was the son of a general practitioner in the small town of Aitkin, Minnesota, about an hour’s drive west of Duluth. An all-star high school athlete, Kerlan first arrived in Los Angeles as a sixteen-year-old to play basketball at the University of California in Los Angeles. After one year at UCLA, he transferred to USC, matriculating both undergrad and medical school. Like so many medical students with an athletic past, Bob Kerlan gravitated toward orthopedics, and after finishing his surgical training, became one of the earliest orthopedic surgeons who steadfastly served as a team physician for professional sporting franchises. In Los Angeles, he had the best seat in the house for every sporting event in the booming fifties and sixties.
Dr. Kerlan was hired just the day before the opening day of baseball for the new Los Angeles Dodgers in 1958. (Having won the World Series in 1955, the Brooklyn Dodgers broke fans’ hearts and ventured west prior to the 1958 season, as did the New York baseball Giants.) He had volunteered for a minor league baseball team for a few years, but this was different. The Los Angeles Dodgers became a dominant team for a decade, and their bold venture signaled the emergence of sports as big business. Dr. Kerlan’s good fortune overshadowed the fact that he was stricken with ankylosing spondylitis.
Ankylosing spondylitis, an inflammatory condition of the spinal column, propels its victims into a forward thrust, turning the flexible human spine into one long, fused, rigid piece of ratcheted bamboo. Slowly, painfully, the patient is turned into a spectacle. Once fully entombed, the sufferer cannot raise his head to look forward. The worst cases result in a vulture’s posture; I’ve seen patients who were forced to walk backward to see where they were walking, similar to the gaze of a jockey looking over his shoulder. Bob Kerlan battled ankylosing spondylitis (AS) his entire professional life, and yet famously maintained his good humor and positive outlook.
Because AS is an inflammatory condition, the treatment requires anti-inflammatory medications, along with physical therapy and exercise. The most commonly used anti-inflammatory in the 1960s was Butazolidin, known around racetracks as “Bute.” In a 1969 Sports Illustrated article, Dr. Kerlan described the use of Bute on Elgin Baylor, Jerry West, Wilt Chamberlain, and racehorse jockeys. Bob Kerlan, himself, was taking Bute and aspirin by the handful, and had another famous Southern Californian taking Butazolidin as well: Sandy Koufax.
Dr. Kerlan continued operating for a decade and a half, but by the early 1970s, his disability was so severe it left him unable to safely navigate the operating room and to manipulate surgical tools, eventually forcing a reluctant submission to his jailer. Undaunted, he persisted in his care of the Dodgers, the Lakers (who had arrived in 1960), the Rams, the Kings, and the jockeys at Hollywood Park. And all the while he cultivated friendships with Hollywood actors like Walter Matthau and Danny Kaye, and the giants of sports from Willie Shoemaker to Wilt Chamberlain. Watching him soldier on, no one bothered complaining to Dr. Kerlan about their aches and pains. In a 1969 Sports Illustrated article, Sandy Koufax said, “His own physical problems are far more serious than most of those he treats, and yet he is always having a good time—telling jokes, kidding people, and getting kidded in return. I always liked him as a doctor, but more than that I liked him as a man.”
Overwhelmed in his unique practice, Bob Kerlan sought the help of a partner. Before the orthopedic surgery community authentically recognized sports medicine as a specialty, in 1965, Dr. Kerlan was able to recruit a genuine and honest young man originally from the small town of Boone, North Carolina—Frank Jobe.
Although he would dramatically change sports by co-creating sports medicine, Dr. Jobe was never particularly athletic, telling me in response to a query about his own baseball prowess, “I was never a very good ballplayer. I realized later that my talents lay elsewhere.” Dr. Frank Jobe had enlisted as an army medic in World War II, triggering a lifelong interest in medicine. After the war, he received all his medical training in Southern California and initially started his own private practice in metro Los Angeles.
When Dr. Kerlan and Dr. Jobe joined forces in 1965, they combined two very different and extreme talent sets. Dr. Kerlan’s tremendous interpersonal skills married to Dr. Jobe’s incredible innovative surgical insights; the art of medicine matched with scientific research; a body ravaged and limited by disease joined with superlative, gifted hands. The Kerlan-Jobe Orthopedic Clinic was born, and in the City of Angels, it was a match made in heaven. The two men joined together to form a working unit that superseded any one man’s gifting.
Dr. Kerlan could work a room. I have never met a person who, when questioned about the man, didn’t tell me a side-splitter. (Dr. James Andrews is the unquestioned king of sports medicine in the world today. While still at the Hughston Clinic in Georgia, Dr. Andrews came to Los Angeles for visits in the ’70s with Dr. Kerlan. These visits left a deep impression on Dr. Andrews, and he told me, “Dr. Kerlan was THE MAN!” He held me by both elbows when he said it, so important was it for me to understand that statement.) Frank Jobe was the down-to-earth, matter-of-fact foil to Bob Kerlan—his straight man. No less dedicated to his patients or his craft, Dr. Jobe was a once-in-a-lifetime surgical innovator, scientist, and visionary. While Dr. Kerlan was a jester and bon vivant, Dr. Jobe was more literal and less hands-on (ironic, in that it would be Dr. Jobe’s hands that would change the baseball world).
Tommy John is a person, a patient, a ballplayer. Baseball fans remember him primarily as a player for the LA Dodgers, Chicago White Sox, and New York Yankees, who underwent the most famous elbow operation in history on September 25, 1974. In the field of medicine, syndromes and conditions are almost always named for the physician who first described them (infrequently, a disease is named for the location in which the disease occurred, such as Ebola and Lyme). Thus, we know the names Parkinson, Huntington, Hodgkin, and Marfan—the physicians who describe the disease and not the names of the patients who suffered the maladies. Almost without exception, the names of the victims are lost to history, with the notable exception of Lou Gehrig. Every baseball fan knows the name Tommy John: the name attached to the triumphal solution to a failed elbow.
Dodger fans had watched another phenomenal lefthander, Sandy Koufax, surrender to a failed elbow a decade before. Neither Sandy Koufax nor Tommy John was able to undergo an MRI of their elbows—MRIs were not commonplace until the 1980s. A torn elbow ligament (the medial collateral ligament) was only a clinical (“hands-on exam”) diagnosis. Following a traumatic injury in the midst of the 1974 season, Tommy knew that he couldn’t throw anymore—his injury was not the subtle presentation that most baseball docs see today, but was instead a grossly unstable, floppy elbow.
Dr. Jobe examined John’s elbow at Dodger Stadium and initially recommended placing the southpaw’s arm in a cast for a trial period. No doubt Dr. Jobe was thinking about Sandy Koufax and the collapse of his career in 1966. Two years earlier Dr. Jobe had operated on Tommy’s left elbow, removing bone chips, and following dedicated rehabilitation, Tommy returned to excellent form. Now, Tommy John was facing certain doom and the end of his career. Realizing that splinting was a failure, and sitting together in Dr. Jobe’s office, the two men discussed reconstructive surgery. After a “night to think on it” Tommy said, “let’s do it.”
Tommy John’s willingness to undergo surgery underscores the change in mindset away from surgery as a last resort. No surgeon, however, had operated on the ulnar collateral ligament of the elbow. While a professional athlete often equates a career-ending injury with death, most sports medicine operations are entirely elective; life could easily go on without surgery. Tommy was sailing into uncharted waters, placing his limb and his career entirely in Dr. Jobe’s hands, trusting that Dr. Jobe had the creativity and skill to accomplish what no other surgeon had.
What makes a great surgeon? From William Halsted to today’s notables, a requisite set of characteristics sets apart the heroes. Many patients don’t realize that many, perhaps even most, surgeons are not superlative. A high percentage of surgeons have adequate hand control, but not special. Very few practitioners are true innovators who have breakthrough creativity when thinking about injuries and diseases. They have a three-dimensional understanding of anatomy—the kind you can “feel.” It’s a concept that is difficult to describe, but is most like someone who has a great sense of direction, driving in the dark in an unfamiliar part of town, and yet, still knows the way home.
A phenomenal surgeon has vision, poise, insight, skilled hands and (surprisingly) humility. Poise is what the “clutch” player has who actually wants the ball at the end of the game. When the airline pilot Chesley “Sully” Sullenberger realized his aircraft was doomed as his first officer was taking off from LaGuardia, he calmly said, “My aircraft.” His first officer, following protocol, said, “Your aircraft.” Every pilot, surgeon, and true leader who heard that story nodded to him or herself in knowing agreement. Surgeons who throw massive tantrums in the OR (there are many) usually betray the fact that they do not do well under pressure, and the “macho” display is actually an admission that their nerves also do not do well under pressure.
Insight is a way of incorporating all your teaching from a very diverse group of mentors and specialists in many different disciplines, and accessing it, sometimes on the fly, to critically problem solve. Skilled hands—truly gifted hands—are characterized by naturally tremor-free control, powerful yet dexterous, elegant and sensitive to touch yet able to make rapid, precise moves. A cross between Itzhak Perlman and Norm Abrams. Humility rounds it out. Knowing when you are at the limits of your powers, when another surgeon is better at a particular procedure, when you were wrong—and admitting it.
Finally, the best sports medicine practitioners today all have one thing in common: an overwhelming ability to communicate to their patients “all will be well.” This is usually accompanied by physical touch: a comforting pat, a solemn reassurance.
To those who were blessed to be in his sphere, Dr. Jobe was all things.
The groundbreaking elbow operation was performed at Centinela Hospital on September 25, 1974, but it can be hard to know what happened forty-five years ago in an operating room in Inglewood, California. I was fortunate to know both Dr. Jobe and Tommy John, but we also have a detailed report in a 1986 publication. The Journal of Bone and Joint Surgery (JBJS) is the bible of orthopedics, and although it is surprising that it took over a decade to publish “Reconstruction of the Ulnar Collateral Ligament in Athletes,” Drs. Jobe, H. Stark, and S. J. Lombardo give us interesting tidbits about the important operation in 1974. Typically, medical journal articles are exceptionally dry reading, and even case reports contain only bland information about nameless patients. But in the JBJS article, we find Case I, a twenty-nine-year-old professional baseball player. This is obviously Tommy John.
The article presents the clinical information about his initial injury, suffered as a twelve-year-old Little League pitcher. Amazingly, Tommy had been injected with steroids approximately twenty-five times over an eight-year time span as a professional. After having his elbow debrided (cleaned up) in 1972, he returned to form, and was actually having a great 1974 season, starting out 13–3. In July, while throwing a hard slider, he felt severe pain and actually felt his elbow snap and give way. We have a stress radiograph labeled “1974,” also obviously Tommy.
Years ago, Dr. Jobe confided to me that the groundbreaking operation was performed with no prior practice on cadaver arms, and with no biomechanical testing to scientifically prove its merits. This is a startling revelation to a younger surgeon, further buttressing the notion that Dr. Jobe was a courageous innovator.
Pioneering surgery of the hand had demonstrated the utility of transferring a tendon from one part of the hand to another when treating polio. Thus, a partially paralyzed leg or arm could regain function. One of the trailblazers in this type of surgery was Dr. Jacquelin Perry, who worked for decades at Rancho Los Amigos in metro Los Angeles, and was a lifelong friend of Frank Jobe. It made sense to Dr. Jobe to harvest one of these forearm tendons, the palmaris longus, which is of little functional importance, from Tommy’s right arm to his left elbow. Amazingly, the body senses that this newly placed tendon from another place belongs in its new home, and quickly begins to vascularize it and bring it to life (in a biological and biomechanical sense).
In the article there is a series of drawings that explain the revolutionary operation, and details the surgical technique. The drill holes are strategically placed in the humerus and the ulna, and if precisely placed (to the millimeter) the new tendon set into the drill holes will replicate the function of the torn ligament. The collateral ligament of the elbow is only about an inch long, and less than the diameter of a pencil. Careful biomechanical studies have (now) shown which part of the ulnar collateral ligament (UCL) is important in throwers: the anterior bundle of the anterior band of the UCL.
When Tommy awakened from surgery, he groggily attempted to feel his right arm. Having already endured left elbow surgery two years before, Dr. Jobe had told Tommy that this new “reconstruction” would entail use of the tendon from his right arm.9 Dr. Jobe had told Tommy there were two eventualities: another simple cleanup, or the new reconstructive operation. Once the Dodger ace felt bandages on his right arm, he knew history had been made.
Dr. Jobe had told Tommy that his chances of returning to play were one in a hundred. After venturing into the sports equivalent of an untethered spacewalk, Tommy came back and famously won more games after his surgery than before. Tommy John surgery is now one of the most reliable operations in all of sports, with a quoted return to play rate of at least 80 percent. A stroke of genius has saved hundreds of baseball careers, and there is not a single major league baseball team without numerous Tommy John “survivors.”10 And because the Tommy John operation is almost entirely elective, only reserved for elite baseball players, in some ways it represents the ultimate expression of the implant revolution, where surgeons now perform operative reconstructions on athletes who play for our entertainment and vast sums of money.
If you were taking a walk on the windswept beach at Kill Devil Hills, North Carolina (just south of Kitty Hawk), on December 17, 1903, you might stumble upon the Wright brothers making history with their Wright Flyer. You likely wouldn’t believe your eyes, but the meaning of manned flight wouldn’t resonate until you saw an airplane full of passengers making a long-distance journey. Similarly, if you were in Los Angeles at the Centinela Hospital operating room on September 25, 1974, you might be intrigued to see Tommy John on the operating table. The deeper meaning of what that moment meant for baseball and sports medicine would be impossible to know until hundreds of baseball players and elite “overhead athletes” would have their careers (and lives) changed by Tommy John surgery. Although sports medicine has many birthplaces, only then would you appreciate that you were at one of those special moments, witnessing a master at work, a humble pioneer helping birth sports medicine.