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The pitcher and the doctor sat down to figure the whole mess out. The pitcher was complaining that his once-mighty left arm was nothing more than mush. The doctor was asking, "What would you like me to do?"

That's when the pitcher sent a high heater buzzing by the doctor's ear — "Make up something," he said.

And so, Dr. Frank Jobe did.

The doctor turned the baseball world on its elbow thanks to the breakthrough surgical procedure he performed on former Los Angeles Dodgers pitcher Tommy John on Sept. 25, 1974.

Dr. Jobe extracted a tendon from John's right arm and used it to replace the torn ligament on his left, pitching elbow, weaving the healthy tendon through holes drilled above and below the elbow.

Immediately after, no one knew what to expect, because such a surgery had never been performed.

"I was just hoping for the best," John said earlier this week. "That was all I could do."

Turns out, it was the greatest thing that could have happened to John, and it paved the way for hundreds of pitchers since. John went on to pitch for 14 more years, collected 164 of his 288 career victories after the surgery and never missed a start.

The procedure — known as Tommy John surgery, a moniker that was copyrighted by Jobe — has hit home close to Pittsburgh this season.

Kris Benson returned to the mound for the Pirates on May 13, 11 months and 22 days after undergoing the procedure, and Ryan Vogelsong returned July 5 at Class A Lynchburg, nine months and 15 days following his surgery.

It is too soon to tell if either player will regain his old form —- Benson is 4-5 with a 5.59 ERA since coming back; Vogelsong is 1-3 with an ERA above 7.00 at Lynchburg and Class AA Altoona — but there is no disputing that it has given hundreds of pitchers, like it did for John, a new lease on their baseball life. Upwards of 75 current major-league pitchers have undergone Tommy John surgery.

"It saved my career," said John, the pitching coach for the Montreal Expos' Class AA affiliate in Harrisburg. "Am I a pioneer? No. Somebody had to be first, and that somebody happened to be me."

Forcing the issue

Not surprisingly, refinements have been made with the surgery and rehabilitation during the past 28 years.

For example, where the procedure once took four hours to perform, it now takes about an hour and a half. And, where rehabilitation couldn't begin until the arm was removed from a cast after 16 weeks, it now begins as soon as 10 days later.

Because of the improvements, doctors place chances of recovery at 90 percent. Comparatively, Jobe put John's odds at 1 in 100.

Yet, even with all the enhancements, John feels that many pitchers are trying to rush their returns to the mound after undergoing the procedure. He pointed to Vogelsong, who was pitching for Lynchburg less than 10 months after surgery.

John got a chance to see Vogelsong pitch against Harrisburg on July 23, a day when the 25-year-old pitcher allowed 10 hits and nine runs in four innings.

"Personally, I think they did him a great disservice," John said of Vogelsong, who was optioned to Altoona earlier this week. "He should be in the Gulf Coast League where nobody cares if he gets guys out or if he doesn't. How good the talent is that he's facing is immaterial in the comeback process. He pitched against us and didn't throw the ball well.

"He's out there throwing in Class AA for a team in a pennant race and that's not fair to him. You have to take him someplace where nobody's in the stands except scouts and girlfriends. He's still in the infancy of his comeback and it's too much too soon."

John returned after 19 months — nearly eight months longer than it's taken Vogelsong and Benson — but it should be pointed out that his arm was in a cast for 16 weeks, leaving it atrophied when the cast was removed.

He acknowledged that things are much better now, but he is still against the 8-10-month comeback. The average return for a comeback is 11.8 months, according to a recent study in The Sporting News.

"Everybody wants to be the pitcher who came back quicker than anybody else," John said. "Who cares? I mean, who really cares if I can name that song in three notes or if I can name it in six notes, it doesn't matter as long as I name that song. It's the ego of the ballplayer.

"If I were Vogelsong or anybody else who had the surgery, I would wait. If it takes a year, 18 months or two years, so what? These guys are young. They shouldn't push it."

Moving along

Despite John's concerns about early comebacks, the majority of pitchers return within a year, including the Pirates' Benson.

The former No. 1 draft pick, who, along with Vogelsong, had his surgery done by the renowned Dr. James Andrews, claims the arm was as good as new when he made his big-league return against the Arizona Diamondbacks, who knocked him around for seven earned runs and 10 hits in 3²/₃ innings May 13.

"You might struggle when you first come back, but it has nothing to do with the injury at that point," Benson said. "It's more a matter of getting used to performing at a high level again. That's the big thing, because the arm is fine after the surgery. It's all about fine-tuning things and getting yourself back to normal."

Asked if he would have been better off waiting just a little longer, Benson did not hesitate with an answer.

"No," said Benson, who's been improving of late, including a win over Colorado five days ago in which he allowed a run and three hits in eight innings. "You have to get back out there when it's time. That's just how it is."

Vogelsong feels the same way.

"When you're ready, you're ready," Vogelsong said. "There are a lot of smart people who work with us, and they wouldn't put us out there if they felt it wasn't the right time."

Pirates trainer Kent Biggerstaff has worked with more than 15 players who have undergone the Tommy John procedure and has witnessed impressive results.

"With the exception of one guy — and he was an older player who eventually retired — every person we've worked with who's had Tommy John surgery has come back at the same level or higher," Biggerstaff said. "The only difference for each individual is how they go about their rehabilitation program. If they stay with us, they're going to rehab every day; if they go on their own, they'll rehab three times a week.

"So, the surgery is going to work, the only real question is how soon will a guy come back? You never force it. You just make sure he's done all he's needed to do, then you move on from there. In the cases of Kris Benson and Ryan Vogelsong, they were here every day working to get back, which is why they got it done in under a year."

The good news

After Tommy John surgery, players generally come back stronger. That's encouraging information for guys such as Benson and Vogelsong.

"It's amazing what this surgery has done for me," Benson said. "It's like I get to start over again, only I have a chance to be even better."

Studies have shown that once rehabilitation is complete, many players add a few more miles per hour to their fastball. That's because the transplanted tendon has three times the amount of collagen — the substance that makes up cartilage — than the original tendon.

That helps to explain why pitchers such as Mariano Rivera, who had the surgery as a minor leaguer in 1992, is one of the game's top closers and why Matt Morris elevated himself into one of the top pitchers in the league after surgery in 1999.

Perhaps the greatest example of them all is Tommy John himself, who improved by leaps and bounds after the procedure. To wit: John never won 16 games before the surgery, but won 20 games his first season back and 22 games several years later.

"I don't want to toot my own horn, but the proof is in the numbers," John said. "We didn't have radar guns back when I was throwing, but all I know is that we were winning. If these guys do what they're supposed to do, rehab correctly and work hard at it, they're going to be successful with this.

"And they can all thank Dr. Jobe for making it possible."

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