ABSECON – Tommy John elbow surgery used to be considered a last-ditch effort to salvage an injured pitcher’s career.
These days, with advances in medical technology and rehabilitation, it’s more like general maintenance or a tune-up. It can actually add mileage - not only to a pitcher’s career but to his fastball.
That’s the hope for Holy Spirit High School senior right-hander Billy Kral, who had the elbow surgery last September. He is far along in his post-surgery rehab and conditioning program but will likely not pitch this season for the Spartans, despite what looks at this stage like another Tommy John success story.
“I feel a heckuva lot better now than I thought I would have at this point,” said Kral after a recent game against St. Joseph in which he served as designated hitter. “I’m cringing not being able to get out there with everyone … I’m going to do everything I can to get back out there, maybe in the playoffs. It’s all up to my surgeon. I’ve got to get the OK from him.”
The surgery, in which a torn ulnar collateral ligament is replaced with a tendon from the patient's forearm or (in Kral’s case) hamstring, was created by orthopedic surgeon Dr. Frank Jobe and first performed on major-league pitcher Tommy John in 1974. Before his surgery, John had won 124 games. He won 164 after surgery, retiring in 1989 at age 46.
At the time of John's operation, Jobe put the chances for success of the operation at one in 100. By 2009, prospects of a complete recovery had risen to 85–92 percent. The surgery has become commonplace among big league players, and many pitchers – Adam Wainwright, Stephen Strasburg, Matt Harvey and Yu Darvish, to name a few – have returned to their pre-injury levels of performance.
Kral, 18, has been pitching since he was a Margate little leaguer. He said he began to feel his arm wearing down and his velocity dropping toward the end of his junior season at Holy Spirit. He had an MRI (magnetic resonance imaging) on the elbow and was diagnosed with a partial UCL tear. It was thought that rest and rehab would be enough, but when the elbow flared up again, he decided to have the surgery, which was performed by Dr. Michael Ciccotti of the Rothman Institute in Philadelphia.
“The technology these days is crazy,” said Kral, who also had an ulnar nerve transplant, a common “sidekick” to Tommy John surgery.
“Ten years ago the surgery was a totally different thing than it is now. It’s so much more advanced. It’s kind of just a matter of time. If you throw hard, if you pitch, if you want to go far, pretty much everyone is going to get it nowadays. You see the big-time prospects who get it and come back. Some are even throwing harder after the surgery.”
Kral said a “big piece” of his decision to have the surgery was the experience of Holy Spirit assistant coach Jason Downey, who had the surgery as a junior at Rutgers University in 2009 and came back to pitch his senior year. Downey is still pitching these days in the Atlantic County Baseball League.
“He’s been great through my rehab,” Kral said of Downey. “He knows what you’ve got to do to get back on the mound.”
Kral has been working to improve mobility in the elbow and strengthen surrounding muscles with Dr. (Ryan) Buccafurni at Integrity Physical Therapy in Northfield. At the height of his rehab program, he worked out at Integrity up to four days a week, exercising with elastic bands and undergoing “dry needling” to improve shoulder motion.
“My shoulder is stronger right now than I think it’s been in the past five years,” Kral said. “You specifically work on things you wouldn’t think to work on to play this position. There’s definitely upsides to it.”
“They have increased the workload in trying to get back,” Downey said of the rehab. “You’ve replaced that ligament, but you’re also building up everything around it, not to mention the work you’re doing to build up the rest of your body, because pitching is a full-body movement. He’s taking that very seriously, getting his body in shape.
“It’s a 13 step process, and with each step he’s shown an increase in strength,” Downey said. “I have no concerns with him coming back and being at full strength and getting right back to where he was, possibly even going beyond from a velocity standpoint. You don’t see that with everybody. I’ve played with a lot of guys, and the ones that have gone the furthest either haven’t been injured, or they got injured and something clicked. The fire lit within them to come back stronger, and he’s in that second group, for sure.”
Kral committed early, before his junior year, to attend Division I Hofstra University in Hempstead, N.Y. on a baseball scholarship. The school has not reneged on its offer, sticking with Kral through the surgery and rehabilitation process.
“I was nervous when I knew I had to get the surgery,” he said. “I had to call up there, and I thought I was going to get a negative response, but he (head coach John Russo) was good. It was good timing. I should be good to contribute in the fall and try to win a spot in the spring for them.”
Kral will join two other South Jersey pitchers at Hofstra: Zach Altieri from Ocean City and Seamus Brazill from Barnegat, both sophomores. “That was a big reason I’m going where I’m going, the coaching staff and players,” Kral said. “I knew they were the guys I wanted to spend my college career with.”
“You have to give them a lot of credit, because they’re going to hold true to the offer that they extended to him,” Downey said of Hofstra. “But then again, they’re going to get a guy with basically a clean bill of health. There’s going to be no unforeseen problems, as long as he comes back. It’s a testament to his family and the coaches up at Hofstra. You’re dealing with first-class people.”
As a sophomore, Kral helped the Spartans win their first Non-Public state championship in 33 years. He may not be able to help them get back there with his arm, but he can still swing a hot bat.
“I’m just happy to be able to pitch in whenever I can,” he said. “It’s better than sitting around all year.”