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Kellen Sillanpaa remembers the big games.
There was a no-hitter in the championship game of a travel tournament when he was 12; the "120-pitch epoch," where nobody came close to hitting it out of the infield; and the high school playoff game in which he struck out the side in relief as a freshman.
Sillanpaa was competitive, talented and threw hard. College recruiters were watching. But there was a problem. Sillanpaa kept throwing through elbow pain and eventually needed Tommy John elbow surgery, from which he never fully recovered.
The procedure, in which a pitcher's ulnar collateral ligament in his throwing elbow is reconstructed, has become a topic of national conversation with 28 major leaguers having the surgery or expecting to have it this year. But the injury is also shutting down players years before they reach the big leagues, with the number of procedures at the youth level rising at an alarming rate. James Andrews, the famed orthopedic surgeon, has called it an epidemic.
In 2000, Andrews and his colleague, Glenn Fleisig, reported performing Tommy John surgery on 17 youth and high school players, making up 18% of all elbow reconstructions they did that year. In 2010, the last time Andrews and Flesig collected the data in a similar fashion, there were 41 surgeries on kids, making up 31% of the procedures. And Andrews says the stats have gotten worse.
"The largest number of all those different groups, believe it or not, is high school kids," Andrews told USA TODAY Sports. "They outnumber the professionals. There was a tenfold increase in Tommy John at the high school/youth level in my practice since 2000. I'm doing way more of these procedures than I want to."
Furthermore, kids are less likely to return to their previous form after the surgery, dispelling the notion that pitchers should get Tommy John surgery as soon as possible because it will help them throw harder.
Andrews said the success rate of the surgery on children is lower than it is for adults.
"When we say 'success,' that means they go on to play baseball," he said. "There's a higher failure rate than older pitchers, because they're so young and just don't know how to get through the surgery."
Andrews said 25% to 30% of kids who have Tommy John surgery aren't playing baseball two years later.
That doesn't necessarily mean the surgery failed. It could mean a player lost his scholarship or his position or just never got back to playing.
Count Sillanpaa among those out of the game as he prepares to head to college.
"It's just hard," said Sillanpaa, who lives in the San Francisco suburb of Fairfield. "You grow up spending so much time thinking about playing in college and how awesome it's going to be."
'IS IT WORTH IT?'
Sillanpaa, 18, said he plans to study political science at Southern California in the fall. Once upon a time he thought he would also be playing baseball at Stanford, Washington or Cal Poly, the schools that expressed interest in the 6-1, 180-pounder when the speed in mph of his pitches was in the mid-80s.
"We had an all-state pitcher on our varsity that had just left and went to Arizona, and I thought that Kellen could have been that kind of player and maybe something more," said Jason Chatham, Sillanpaa's coach at Rodriguez High in Fairfield. "He was a really talented kid."
But Sillanpaa had Tommy John surgery when he was 16 and ulnar transposition surgery, which repairs the nerve near the funny bone, two years later, and that was the end of baseball.
"I can honestly tell you that I worked harder than anybody else," Sillanpaa said. "I can't hit 80 (mph), I play like crap and have a second surgery on my arm. It's like, 'Is it worth it?'"
Sillanpaa first noticed soreness in his left arm when he was 9, but it didn't affect him, he said. By the time he was 13, it became an issue. He went to see Arthur J. Ting, an orthopedist who has treated prominent Bay Area athletes, including former San Francisco Giants outfielder Barry Bonds. Ting said Sillanpaa's elbow was structurally sound, although he put Sillanpaa in a brace for six weeks.
Sillanpaa gave up football and basketball and devoted himself to travel baseball. By the time he was a high school freshman, Sillanpaa starred for the junior varsity and varsity teams. But Sillanpaa struggled in a tournament the next summer and went back to Ting, who said his UCL was not torn.
"He said if I were a big-leaguer and was having as much trouble as I was, he probably would have just done the surgery even if the MRI didn't show it was torn," Sillanpaa said. But because of Sillanpaa's age and the fact he was still growing, Ting advised against the surgery.
After taking another break and lifting weights in preparation for his sophomore season, Sillanpaa took the mound for a scrimmage and felt a twinge in his elbow. He lost velocity on each subsequent pitch, from 85 to 80 to 77. He had an MRI and continued to throw while waiting for the results. The verdict was in: Sillanpaa had torn the UCL and needed Tommy John surgery.
"All that falls on me as his dad," said his father, Ted Sillanpaa. "Looking back, hindsight, if I had known when he was 11 or 12 that he was going to be a Division I prospect or somebody that scouts thought could get drafted when he was 14, I'd have given him a (pitch count). My experience was that at that really young age, it's just about playing and having fun and making memories."
RULES FOR HIGH SCHOOL
Sillanpaa rehabbed for a year after the surgery but didn't feel right as he entered his junior season.
"Everybody would always tell me, 'Kellen, you have the surgery, and it'll be like you have a brand-new arm,'" he said.
It's much harder for young pitchers to come back from Tommy John surgery than professional athletes because major league teams are financially invested in their players.
"They've got them for the long haul," Andrews said. "They've got the best of care, a full-time trainer and therapist with them every day. They continue to get paid, so they can survive while they're getting well, and the team sees them fitting in 10 years down the road for longevity.
"In high school, everything is a hurry-up. Same thing in college. 'I've gotta be well by senior year so I can get a scholarship.' 'I've gotta be well by junior year in college, so I push, push, push so I can enter the draft.' If they finish college and haven't gotten well from the surgery, what do they do then? They're in limbo. They gotta go play independent ball or something. It's a problem with these younger age groups."
Sillanpaa's discomfort eventually turned into nerve pain, though he kept pitching. Finally Ting said he needed ulnar nerve transposition surgery.
"I've never had in my career a harder-working kid. And that's not hyperbole," Chatham said. "Kellen was the hardest worker, so I know that everything that could have been done in order to get his body back into shape was done. He followed the directions of the doctor, and he worked out every part of his body in order to alleviate stress on his arm and on his elbow."
In 2007, the Little League International board of directors unanimously approved pitch count limits based on research conducted by Andrews and Fleisig. Andrews said injuries at that level have dropped by 30%. His next project is to get similar rules adopted by each high school athletic association.
"You can't go through the federal government and say change the rules in all 50 states," he said.
This is how the game gets changed. Kids think if they can throw an 85-mph fastball they'll get recruited, and they're right, because Division I coaches and big-league scouts look at velocity. Therein lies the problem.
"The coaches are looking for that, unfortunately," Andrews said. "We need to de-emphasize that at all levels. That's what's happening in the pros, too. We've got guys that two years ago were throwing 85 and now are throwing 95. How does that happen in two years? And they're throwing their ligament out right and left."
After all of the pain and two surgeries, Sillanpaa doesn't like to watch or talk about baseball.
"I'm not one of those guys where sports is everything and if I get hurt and can't play anymore, then the whole rest of my life is going to be ruined because I can't do anything else," he said. "But on an emotional level, I've spent so much time thinking about this, it feels like there's something missing."