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06/13/11 8:16 PM ET

Tommy John surgery isn't always risky business

Five and a half years ago, the Red Sox cut a $51.1 million negotiation deal with the Seibu Lions of Nippon Professional Baseball and tied up another $52 million on a six-year contract, betting big time on the arm of Daisuke Matsuzaka. It was a gamble that didn't work out so well.

Thirty-seven years ago, Dr. Frank Jobe cut into the elbow of pitcher Tommy John, tied up a spare tendon to replace an ailing ligament and bet that there was a slim chance John could return to the mound. It was a gamble that changed baseball forever.

So what are Dice-K's prospects? Well, if you're asking will he ever pitch again for the Red Sox, the answer is likely no. The recovery from ulnar collateral ligament reconstructive surgery, aka Tommy John surgery, varies, but it generally takes 12-14 months. If he were to return as the 18-win Dice-K of 2008 that might be something to look forward to. If he were the four-win version of '09, why bother? But it's a good bet that he'll pitch again ... somewhere.

"Chances are his elbow will be in good shape," said Dr. Arun Ramappa, chief of sports medicine in the Carl J. Shapiro Department of Orthopedic Surgery at Beth Israel Deaconess Medical Center. "This kind of reconstruction is well proven with consistent results. We have a long history of pitchers coming back and doing well."

The elbow may be a relatively simple joint when you compare it to the complexity of the shoulder, but it is no more immune to the incredible stress that pitching puts on the body. Damage to the ulnar collateral ligament is a common result of the repetitive throwing motion.

"It's an issue for all types of pitchers," Ramappa said. "Even pitchers who are asymptomatic, who don't have elbow pain, can show partial tears when they have an MRI. It's often the accumulation of a lot of little injuries rather than one event."

John was 12 seasons and 124 wins into his Major League career when he tore his ulnar collateral ligament in 1974. When Jobe proposed the surgery, John's only other option was retirement.

"With the exception of the instruments we use these days, the procedure hasn't changed all that much," said Ramappa. "We re-establish the stability of the joint by drilling holes in the ulna, which is one of the bones in your forearm, and the humerus -- that's the bone in your upper arm. The surgeon will take a non-essential tendon from your forearm and thread it through the holes in a figure-eight pattern. Usually, it's secured by sutures, sometimes by screws."

John would miss all of the 1975 season, but he opened plenty of eyes when he went on to win another 164 games over the next 14 seasons. Nowadays, nobody even blinks when the prospect of Tommy John surgery arises. Some folks think that pitchers come back stronger. Mark Dynan, a physical therapist and orthopedic clinical specialist at Beth Israel Deaconess Medical Center, has some insight into that.

"It's a long, long recovery and rehabilitation for these guys," said Dynan. "They know their own responsibility to the program, and if they are diligent and committed, they are not only going to return with a healthier elbow, they are going to be in better condition overall, with better mechanics and well rested."

The rest begins immediately after the surgery, with the arm immobilized and protected. Work to regain a range of motion begins at about one month, and light exercises and weight work can begin in another two or three weeks.

"By the time they are three months post-surgery, we will have pitchers begin to simulate a throwing motion," Dynan said. "They probably won't get to actually throw for another month, but you've got to understand that for the entire time, we are also working on strengthening their core and lower body. We are educating them about how to use their legs more efficiently and effectively to reduce the strain and decrease the chance of injury."

So it's not the tendon that speeds up the two-seamer? Not the suturing that makes a better slider?

"No magic bullet," said Dynan. "Pitchers may have the motivation of potential multimillion-dollar contracts and the luxury of making their recovery their full-time job, but in the end, the result is the same for them as is it for anyone rehabbing from surgery or an injury. You won't come back to 100 percent if you're not going to put in the effort."

Jobe performed that first surgery six years before Dice-K was born. It will be interesting to see if Matsuzaka is reborn as a pitcher -- wherever that may be.

Gary Gillis is a contributor to MLB.com. The BID Injury Report is a regular column on redsox.com. Beth Israel Deaconess Medical Center is the official hospital of The Boston Red Sox. This story was not subject to the approval of Major League Baseball or its clubs.