Is “Conservative Treatment” Not Enough? Who Pays for It? The Reality of “Tommy John Surgery” That Saves Professional Baseball Players
[Part 2]
Some pitchers are opting for “conservative treatment”
On August 15, former MLB pitcher Tommy John passed away at the age of 83.He is best known for undergoing the world’s first ulnar collateral ligament (UCL) reconstruction surgery in 1974, performed by Dr. Frank Jobe.
This surgery, which was groundbreaking at the time, came to be known as the “Tommy John surgery” after its first patient, and has since saved the careers of thousands of pitchers in Japan and the U.S. over the past half-century.
For example, Shohei Ohtani (32) of the Dodgers and Yu Darvish (40) of the Padres have each undergone the procedure twice during their careers. In the NPB as well, players such as Haruto Takahashi (30) of the Hanshin Tigers,Hiroto Saiki (27) of the Hanshin Tigers, Iori Yamazaki (27) of the Yomiuri Giants, Atsuki Taneichi (28) of the Chiba Lotte Marines, and Katsuki Higashi (30) of the Yokohama DeNA BayStars have all returned as their teams’ starting pitchers after undergoing Tommy John surgery and rehabilitation.
The main reason an increasing number of pitchers are opting for Tommy John surgery to treat elbow injuries is that there is no end to the number of pitchers who go on to perform at a high level after their return. However, baseball analyst Shohei Tateyama, who has undergone the surgery three times, explains:
“It’s not as simple as saying that the ligament in the elbow becomes stronger through surgery, which then increases pitching velocity. Rather, it’s the result of steady, painstaking effort over a year to a year and a half of rehabilitation—reassessing one’s pitching form, dedicating oneself to weight training, and building explosive power—that sometimes leads to an increase in pitch velocity upon return.”
Fearful of the rise of their rivals, they waste an entire season and endure a grueling, seemingly endless process. To avoid this enormous risk, quite a few pitchers opt for “conservative treatment” rather than surgery.
“When Masahiro Tanaka (37) of the Giants tore the ligament in his right elbow in 2014, he opted for a conservative treatment called ‘PRP therapy,’ which involves concentrating platelets from his own blood and injecting them into the affected area. He began rehabilitation in July of that year and made his return two months later, in September.
Yasuhiro Okugawa (25) of the Yakult Swallows injured his right elbow in 2022. Although some team officials reportedly recommended surgery, he opted for conservative treatment,” said a sports newspaper editor.
Since Okugawa pitched only four innings over the two-year span from ’22 to ’23, there were quite a few fans asking, “Why isn’t he having surgery?” However, according to Mr. Tateyama, mentioned earlier, the situation is not quite that simple.
“In Tommy John surgery, a small tunnel (bone hole) is drilled into the elbow bone, and a new tendon is threaded through it. However, for some players, the bone may not be strong or large enough to accommodate the hole. Since there are individual differences in surgical outcomes and the progress of rehabilitation, it’s only natural that the decision requires careful consideration.”
Surprisingly Covered by Insurance
However, while conservative treatment allows for a relatively short recovery period, it carries a higher risk of recurrence than Tommy John surgery. It’s said that an increasing number of pitchers—especially younger ones—are opting for surgery, reasoning, “I’d rather just keep pitching than try to muddle through.”
This naturally raises concerns about the costs of the surgery and post-operative rehabilitation.
“If you receive treatment in Japan, insurance surprisingly covers a significant portion of the costs, so surgery fees range from 100,000 to several hundred thousand yen. On top of that, there are costs for a private hospital room during hospitalization, medical consultations, and braces, but in most cases, the team covers these expenses,” says the sports newspaper editor mentioned earlier.
While many opt for treatment in Japan, some pitchers choose to have surgery in the United States, the birthplace of the procedure. A prime example is Masumi Kuwata (58) in 1995. Dr. Jobe, the inventor of the Tommy John surgery, personally performed the procedure, and Kuwata made a comeback after approximately 500 days of rehabilitation.This year, 31 years later, a pair of young Orix pitchers traveled to the United States.
“In May, Shuhei Yamashita (24) and Taiga Miyagi (25) underwent hybrid-style surgery in quick succession.The surgeon was Dr. Neil Elatroche, who also treated Yoshinobu Yamamoto (28)—a senior teammate of Ohtani’s at Orix. He is also famous for having served as the attending physician for NBA star Kobe Bryant and NFL legend Tom Brady.
Of course, insurance doesn’t cover it. There were reports that when Ohtani underwent surgery, the total cost—including hospitalization fees—was approximately 30 million yen…“It appears Orix covered the surgical costs, but I’ve heard there was some friction between the teams because Miyagi was asked to cover part of the travel and living expenses—which amounted to several million yen—out of his own pocket,” said a sports newspaper reporter covering the Pacific League teams.
If state-of-the-art surgeries in the U.S. become a viable treatment option, the number of pitchers opting for Tommy John surgery is likely to continue to rise.
“If a pitcher thoroughly follows the rehabilitation program provided by the team and doctors, the likelihood of returning to high-level performance after surgery increases. In recent years, surgical techniques have diversified, and rehabilitation devices have been developed one after another, so the risks have been reduced compared to the past,” said Mr. Tateyama, mentioned earlier.
Tommy John surgery is not “magic.” However, it appears it can serve as a powerful “lifeline” to save a pitcher’s baseball career.
From the October 16, 2026 issue of *FRIDAY*
PHOTO： AFLO, Kyodo News, C2/Yuji Arakawa