Rearmed forces: once, elbow trouble meant the end of a pitcher's career. Now, Tommy John surgery has become the salvation of scores of players, as vital to the game as late-inning relief. To understand the impact, follow the comeback trail with an ace, a former ace and the lefthander who started it all. (Baseball).

When he enters the room to examine yet another baseball player's ailing arm, Dr. James Andrews always starts with the same question: Shoulder or elbow?

"I'm almost relieved when I hear it's an elbow," Andrews says.

If the uncertainty surrounding sore shoulders makes Andrews anxious, successfully fixing elbows has become almost routine, even when it is the dreaded medial collateral ligament that needs fixing. In the old days, when a pitcher blew out his elbow, he soon was looking for a new job. Then along came Tommy John and Dr. Frank Jobe, and a busted elbow ligament no longer had to mean a change in careers.

When Jobe performed surgery on John, then with the Dodgers, in 1974, he initially didn't realize how damaged the ligament was in John's left elbow. When Jobe found a ligament so shredded it resembled what an assisting doctor described as a "bunch of spaghetti," he determined John's only chance to pitch again was to give him a new ligament. Jobe decided to transplant a tendon from John's forearm to his elbow, a procedure that had been tried only a few times and never on a professional athlete. After removing the tendon, Jobe attached it to the largest two bones in John's elbow to replace the damaged ligament, and Tommy John surgery, a moniker eventually copyrighted by lobe, was created.

After 18 months of doubts and recovery, John went on to pitch 14 more seasons in the majors and pile up 164 of his 288 career victories, finally retiring at age 46. Hundreds of players--amateurs as well as pros--with the same injury have followed John to the operating table, most of them pitchers because of the tremendous stress the position puts on an elbow. Some come back throwing even harder than before. By THE SPORTING NEWS' count, there are 75 active major leaguers who had their careers saved by Tommy John surgery.

Success stories are everywhere: Matt Morris has become one of the game's top pitchers since his surgery in 1999; Mariano Rivera, who had the surgery in 1992 while in the minors, has turned into the game's best closer; Billy Koch's fastball was docked at a reported 108 mph after he underwent the procedure. There are even pitchers who have undergone the surgery twice, including the Brewers' Chad Fox and the Dodgers' Darren Dreifort. (Both, however, are on the disabled list.)

Because of refinements in the surgery and improvements in the rehabilitation process, chances for a successful comeback have climbed steadily and are higher than ever. Doctors now place chances of complete recovery at 90 percent. In 1974, John was satisfied when Jobe put his odds of pitching again in the majors at 1 in 100.