MLB How Dr. Keith Meister revolutionized Tommy John surgery

Last June, the Texas Rangers acknowledged what had become undeniable: Jacob degrom, the ace starter to whom they committed $185 million in free agency, required elbow surgery.

What neither the Rangers nor degrom, whose words were couched in tears, specified at the time was exactly what kind of surgery. In particular, they never referred to the procedure by its colloquial name — Tommy John surgery.

With good reason. It wasn’t.

Well, not exactly. Degrom became the latest pitcher to undergo a procedure that takes traditional career-saving Tommy John ligament reconstruction and combines it with an extra layer of protection from a synthetic internal brace suture. It is essentially two procedures. It doesn’t have a catchy name. But it has become the calling card of Rangers team physician Dr. Keith Meister.

He’s revolutionized a revolutionary surgery.

The Rangers team physician for the last 21 years, Meister, 62, has become perhaps the world’s foremost authority on pitching elbows. His “hybrid” procedure has become the industry standard.

“I asked him what he would advise if I was his son and this is what he suggested,” degrom said recently. “From my understanding, it’s almost like your body turns [the sutures] into ligament over a period of time. It’s just that much thicker and that much more protection. He’s the best elbow surgeon in the world. When he explained it, I was all in.”

Maybe someday, the Meister maneuver will have a fancy name. In the meantime, he’s too busy to come up with one. He started performing the procedure in 2018, taking a twist on traditional Tommy John, an “internal brace” suture and adding it to the elbow reconstruction. It offered two layers of protection in one.

Business is good. As the hunt for velocity and increased spin advances, pitchers are blowing out in record numbers. Meister said he could do 12 procedures in a week if he wanted. As it is, he now has three offices, including the 21,000 square foot

TMI Sports Medicine and

Orthopedic Center in Arlington. He is regularly sought out by pitchers across the country the minute elbow pain arises.

Degrom wasn’t even his first Cy Young Award winner of last summer. He did Seattle’s Robbie Ray five weeks earlier, then occupied himself with Rangers prospect Kumar Rocker and eventual Ranger Tyler Mahle. And those were just the more notable guys.

Even branched out to football and performed the procedure on San Francisco quarterback Brock Purdy.

According to Jon

Roegele, who tracks elbow procedures online (because everything is tracked online somewhere), Meister has done at least 118 elbow procedures on drafted players or those already in pro baseball. And that’s just the pro guys. Since Dr. James Andrews retired in 2023, it makes Meister the active leader. All in, Meister said he’s done over 300 of the hybrid procedures since he first started doing them in 2018.

“He’s a big believer and develops relationship with players when they’re healthy, so it’s much easier to trust him when they become hurt,” said

Rangers senior director of medical operations Jamie Reed, who as head athletic trainer recruited Meister to leave the University of Florida for Texas in 2003. “He takes time and that’s a separator.”

Hybrid procedure September will mark the 50th anniversary of the first Tommy John procedure on, fittingly enough, Tommy John. At the time, it was called Ulnar collateral ligament reconstruction.

John, a left-hander, had seemingly reached the end of a moderately successful MLB career with what was basically referred to as a bad elbow. In short: The elbow ligament ruptured and there wasn’t a way to repair it. It’s what forced Sandy Koufax to retire in 1966 at age 31.

Dr. Frank Jobe, who became the Dodgers team physician two years after Koufax retired, devised a procedure in which a graft from another tendon, harvested from either the wrist or leg, could be sewn in to repair the tear. It took John another year to return to pitching after the surgery, but he went on to have another 13 years in the big leagues. By the time he retired, John had become the namesake of a ground-breaking, gamechanging procedure.

Over the years, the procedure has evolved. It needed to. Travel and elite baseball mushroomed as an industry, preaching that kids needed to play yearround in search of college scholarships or a pro contract. That put more stress on the elbow.

The hunt for more velocity put more stress on elbows. Likewise, the search for increased spin. More guys’ ligaments failed at younger ages. Pitchers’ reconstructed ligaments started tearing, too.

In the last decade, the “internal brace,” pioneered by Dr. Jeffrey Dugas, became an option. A surgeon can use sutures to simply repair a ligament that hasn’t pulled completely off the bone (known as avulsion). It’s slightly less invasive. The rehab can be a bit shorter. It’s a great option for nonpitchers.

Meister decided elbow repair didn’t have to be an either/or proposition. Why not reconstruct and reinforce the new ligament at the same time? He could, to quote, the Six Million Dollar Man, make it “better, stronger.” If only pitchers still cost only $6 million.

The idea for the hybrid procedure was born.

“I married the two,” Meister said. “I felt like there was enough basic science and biomechanical data to do exactly what I was thinking about doing.”

If the procedure should be named for anyone, then it is probably Kyle Cody. He was the first. In 2018, Cody, then a Rangers minor leaguer, tore his ligament. But when Meister looked at images, there was also a chunk of bone where ligament was supposed to be. He had a huge calcification growing. Meister needed to better anchor his repair. And, well, Cody could use some extra ligament.

Cody represented a perfect test case. He suggested the idea to

Cody. What did the minor leaguer have to lose?

“For 85-90 percent of people, one procedure works just fine. But then what about the 10 percent or 15 percent that it doesn’t? How do we adapt, do it better?” Meister said. “At the elite levels, we are talking about Ferraris. You don’t take care of a Ferrari the same way you do a Toyota.

Cody missed all of 2019, then reached the majors with the Rangers for parts of 2020 and 2021.