In 1968 Dr. Frank Jobe joined the Los Angeles Dodgers medical staff by becoming their resident orthopedic surgeon. It was not until 1974 when Los Angeles starting pitcher Tommy John severely damaged the ligament in his throwing elbow that Dr. Jobe would make one of the most significant contributions to modern baseball.

On September 25th 1974, Jobe was successful in his first procedure of reattaching Tommy John’s ulnar collateral ligament of the elbow (UCL) in a surgery that would later become famously named for the Dodgers left-hander. The surgery is a procedure to reconstruct the medial collateral ligament in the elbow by using a tendon found in the players forearm or sometimes leg. Once the patients arm is opened up, holes are drilled in the ulna and humerus bone and the tendon is woven in a figure-eight pattern to secure and anchor the new tendon across the elbow. The tendon helps to improve stability in the elbow joint and allows a pitcher to continue throwing at a high velocity.

Prior to this innovative surgery, a pitcher with significant ligament damage would often times go improperly diagnosed and his career would essentially be over. In the next 40 years, nearly 500 players have had the ‘Tommy John’ procedure and a large percentage of those players were able to continue their playing career.

But this is not always the situation for players, and Atlanta Braves pitcher Kris Medlen is learning the tragic realization of pitching after Tommy John surgery.

The 28-year old right-hander successfully underwent Tommy John surgery in August of 2010, which caused him to miss the remainder of the year and he would only pitch in two games the following season. Prior to the injury, Medlen had been one of the best pitchers in baseball with a 2.45 ERA in 337 1/3 innings from 2011-2013. He came back in 2012 to have a very strong season by splitting time between the bullpen and starting rotation. Then last season he compiled a 15-12 record with a 3.11 ERA in 31 starts.

Just last week, Medlen left a spring training game against the Mets because of soreness in his right elbow. The next day an MRI showed damage in his surgically repaired elbow and this most likely means the end of Medlen’s 2014 season.

If this wasn’t enough devastating news for Braves nation, the very next day the team learned that pitcher Brandon Beachy might have to undergo the very same season-ending surgery.

On Monday Beachy started against the Philadelphia Phillies and lasted only two innings. Over the course of the game the Braves coach staff became aware of Beachy’s declined velocity, but it was originally considered spring training fatigue. After experiencing tightness in his right bicep, Beachy was sent to Orlando for tests where it was revealed that there is a possible new ligament tear. If the 27-year old were to have season-ending Tommy John surgery, it would be his second surgery on the same damaged elbow in the past 20 months.

“It wasn’t what I would have liked it to have been,” Beachy said of the results. “I was pretty confident when I left the game on Monday. That was based on what I was told. I was being honest. Now it looks like it might be something else. It’s frustrating, very frustrating.”

Prior to his surgery in 2012, Beachy was a rising star in a Braves organization that has seen its share of dominant pitchers. Between 2011 and June of 2012, Beachy started 38 games where he pitched over 200 innings with a 2.84 ERA and over 200 strikeouts.

This past offseason he signed a one-year extension to stay in Atlanta. With this most recent injury news there are significant questions about his future with the organization and as a starter in the majors.

Both Medlen and Beachy will go see renowned orthopedic surgeon Dr. James Andrews on Monday to get a second opinion on how they should proceed with their injures. It is almost certain that Medlen will have the surgery, but with Beachy less than two years removed from his first surgery, it’s quite possible he will be shut down for the season without surgery in order to let his ailing elbow rehab further.

Previous to his surgery in 1974, Tommy John had accumulated 124 wins from 1963 to 1974. After the procedure he went on to win another 164 games in 13 seasons while being named to three All-Star teams and the 1976 National League Comeback Player of the Year. His ability to comeback from this once career ending injury and perform at a high level is what made this procedure a household name for major league pitchers.

Since the first Tommy John procedure the operation has gone on to become standard practice for injured baseball players. Full rehabilitation usually takes one year for a pitcher and about half of that for position players. Players are allowed to begin throwing again four months after surgery. Notable players whose career had been extended because of Jobe’s procedure include John Smoltz, Stephen Strasburg, A.J Burnett, Francisco Liriano, Billy Wagner, Brian Wilson, and Matt Harvey, who had the surgery this past October after being named a 2013 All-Star.

These players, and a large majority of players to have the surgery, have comeback and had solid playing careers. The percent of players to be successful after two surgeries is considerably lower. Doctor Andrews has placed the success rate around 20 percent for pitchers to return to pre-surgery form after a second Tommy John surgery. That percentage is also considerably higher for relievers than starters, meaning the best course for either Beachy or Medlen might be a return to the bullpen.

Now the Braves have to rethink their approach to the season if they hope to defend their National League East title in 2014. On Wednesday, the team announced they signed free-agent Ervin Santana to a one-year contract worth 14 million. This signing certainly helps a rotation made up of Julio Teheran, Freddy Garcia, Alex wood, and rookie David Hale.

The best option for team moving forward might be turning to left-handed pitcher Mike Minor as being someone to step back in the starting rotation. Minor has not pitched this offseason after undergoing a procedure for a urinary tract infection at the end of 2013. It was also reported that he suffered from soreness in his shoulder in the early days of spring training this season. The Braves can also look forward to the return of Gavin Floyd, who is in his first year under contract with the Braves. Floyd, 31, is looking to rebound from his Tommy John surgery last May and is slated to make his debut with the tribe sometime in the early summer months.

Dr. Frank Jobe’s surgery revolutionized the game, but it has not slowed down the number of athletes to be injured and require the surgery. When asked about his top starter needing a second procedure, Braves manager Fredi Gonzalez said, “Tommy John surgery is almost like a root canal.” Gonzalez might have been down playing the severity of the situation, but he and Braves organization certainly hopes the procedure goes as simply as a root canal and that this is the last time either player goes under the knife.