Is Spencer Strider first MLB pitcher to get Tommy John’s alternative procedure?

"Tommy John" have become the most dreaded words in Major League Baseball. The league is currently facing an injury epidemic — pitchers are suffering season-ending elbow injuries at increasingly high rates. The art of pitching is being lost as clubs opt for velocity and spin rate over finesse and sophistication. The emphasis on fast balls, coupled with the league's new pitch clock rules, have led to increased stress on pitchers' elbows.

There were 275 major league pitchers who had Tommy John surgery last season, according to The Athletic.

Tommy John surgery is required to repair damage to the ulnar collateral ligament (UCL), which attaches the upper bone of the arm, the humerus, to the ulna, a forearm bone. While injections can provide temporary relief, a full reconstruction is often required to repair the damaged elbow. The surgery replaces the existing UCL with a graft from a hamstring tendon, the Palmaris tendon, or a cadaver. The new tendon is attached by drilling holes in the humerus and the ulna and threading the graft through the two holes.

But as sports medicine has evolved, surgeons have found ways to improve the Tommy John procedure since it originated in 1974. In recent years, a new surgical technique called the internal brace has become popular.

Spencer Strider is the latest pitcher to undergo Tommy John alternative

Atlanta Braves right-hander Spencer Strider underwent surgery on Friday to repair his UCL, but he did not have a Tommy John procedure. Instead, Strider opted to go with an internal brace, a new surgical technique that has become increasingly popular for athletes who have not completely torn their UCL.

Although Strider will still miss the remainder of the 2024 season, the internal brace could lead to a shorter recovery time. Recovery time from internal brace surgery is typically about 12 months for pitchers, compared to 14-16 months for Tommy John surgery. It also provides better chance of success for pitchers who are undergoing their second Tommy John surgery. Strider underwent the procedure in 2019 at Clemson.

The procedure is more common among younger athletes since it uses existing tissue, which deteriorates by the time players make it to the majors. The pitcher could end up requiring a Tommy John surgery if the tissue doesn't heal reliably. Still, Strider isn't the first major league pitcher to opt for the internal brace procedure.

According to Jon Roegele's Tommy John surgery database, St. Louis Cardinals pitchers Mitch Harris and Seth Maness were the first major league pitchers to opt for the procedure in 2016. Harris did not make a return to the majors, but Maness was able to return just nine months after his surgery.

Matt Bush of the Texas Rangers notably received the internal brace procedure on Sept. 1, 2018, but he later required Tommy John surgery. Bush would not return until Apr. 3, 2021.

In 2021, Tampa Bay Rays' Nick Anderson didn't return for 18 months, but Texas Rangers pitcher Eli White was able to return in seven months.

Along with Strider, Jonathan Loaisiga and Lucas Giolito have both opted for the internal brace this season. Strider's internal brace procedure was performed by Dr. Keith Meister in Arlington.

Surgeons Neal ElAttrache and Keith Meister are opting to include an internal brace with the traditional graft in UCL reconstructions. Shohei Ohtani and Jacob deGrom are among several players who have gotten an internal brace along with the Tommy John surgery in hopes of reinforcing the traditional graft.