Let’s assume Jacob deGrom’s $185 million right elbow has been examined recently by Keith Meister, one of the Texas Rangers’ team physicians and the one entrusted with treating such joints; Meister, in his twentieth season with the ball club, declines to discuss specific patients, citing HIPAA regulations.

When deGrom went on the injured list with elbow inflammation last weekend, the franchise could rest assured that its ace pitcher would be in good hands—maybe the best in baseball. Meister, along with the Los Angeles–based Neal ElAttrache, is among the most sought-after orthopedic surgeons in pro sports, especially when it comes to elbow reconstruction, better known in baseball as Tommy John surgery. Meister reviewed deGrom’s injury history, which included a 2010 Tommy John operation not done by Meister, before the team signed him as a free agent last December. DeGrom’s recent elbow troubles aren’t expected to keep him off the field for long. (ElAttrache performed Tommy John surgery on Philadelphia Phillies slugger Bryce Harper, whose return to the field this week set a new record for major league post-op recovery time.)

“Almost anybody who’s got an elbow injury in any sport seeks [Meister’s] opinion,” said Jamie Reed, the Rangers’ senior director of medical operations. “He’s probably considered one of the top one or two elbow surgeons in the country.”

Meister, fit and trim at 61 years old, could impress any sports fan with a recitation of his high-profile patients. The walls of his Arlington sports medicine clinic are lined with framed jerseys of major leaguers who’ve received treatment there, from three-time Cy Young award winner Justin Verlander to rising star pitcher Tyler Glasnow of the Tampa Bay Rays to former Rangers outfielder Shin-Soo Choo. When I visited the clinic to interview Meister this spring, injured Rays pitcher Jeffrey Springs walked into the lobby with a massive contraption on his left arm.

“I wanted to do from day one what I’m doing now,” said Meister, a native New Yorker whose grandfather, Jacob Kalin, was also a surgeon. “But I had no idea what it was going to be like. There’s no way you could conceive of the commitment and the time. No idea. No idea!”

Reed—who joined the Rangers as athletic trainer in October 2002 and convinced Meister, then a member of the University of Florida sports medicine faculty, to make the move to Texas—called the surgeon “the best thing that’s happened to Texas Rangers medicine.” The vast majority of Meister’s patients are baseball players, mostly pitchers (Meister prefers to call them “throwers”). One recent patient from another sport was San Francisco 49ers quarterback Brock Purdy.

Meister doubled as team physician for the National Hockey League’s Dallas Stars for three seasons early on before the workload convinced him to stick with one team. He attended every home ballgame during his first seventeen seasons with the Rangers, though he often didn’t stay for the first pitch. Most important to Meister was visiting beforehand with as many players, coaches, and front-office executives as he could. “This business is about relationships,” Meister said. “You have to build a presence and relationships and then a level of confidence. If you want to begin to have an impact in the game, it’s going to take you at least ten years of being there every day. And if you’re willing to commit to it, you’ll then begin to see the rock move a little bit.

“Sports medicine within baseball is a very, very small niche,” he added. “There are very few of us that get trusted to do the things that we do.”

Meister said he can’t count all the Tommy John surgeries he’s done. His first came in 1992 during a fellowship with Alabama’s James Andrews, a sports medicine pioneer whose specialty joint is the knee. Meister calls Andrews his second father, and his admiration extends well beyond the operating room. “I learned a tremendous amount from him in how to deal with people,” Meister said. “He was so down to earth. When he came into a room, you knew that it was you that he was focused on.”

That quality reminded Meister of his grandfather. “Any patient that ever came into his office,” Meister recalled of his grandfather, “he never allowed the patient to leave the office empty-handed. He used to say this to me: ‘Always give them something.’ ”

Tommy John surgery is named for the big-league pitcher who first underwent the procedure in 1974. After he’d torn the ulnar collateral ligament in his pitching elbow, the surgeon Frank Jobe removed the damaged tissue and replaced it with a piece of tendon, which would act as a new UCL. John was 31 years old at the time of his injury, and the operation added another 15 years to his career. Almost 50 years later, Meister said his version of elbow reconstruction has evolved beyond the ligament replacement into four types of reinforcement procedures, dictated primarily by the sport an athlete plays and the position within that sport, as well as the number of years most athletes would expect to continue playing at the patient’s age. “I came up with a procedure called the hybrid procedure, where I put a tendon graft in with a brace, and I started doing those about five years ago,” Meister said. “That’s kind of evolved into our primary procedure now.”

A Tommy John operation typically takes just under an hour for Meister to complete, with a 90 percent success rate. Some patients require a second procedure, with a success rate of about 55 percent. Current Rangers pitcher Cole Ragans is in the latter category. Ragans was a first-round Texas draftee out of high school in 2016. He required Tommy John surgery in March 2018 and then again in May 2019, the second operation caused by what Ragans called a freak accident.

Ragans missed 2020 because the pandemic wiped out the minor league season, returned to pitching in 2021, and spent two seasons as a starter, primarily in the minors, before being moved to the Rangers bullpen this spring. “I have a routine,” Ragans said, “and I know if I stick to my routine then my arm will be ready to go.”

Elbow surgery techniques are likely to continue evolving with changes to the way baseball is played and the different types of stress pitchers put on their throwing arms. That’s good for business, Meister said, but it can also be vexing. “The average fastball velocity went from 89 [miles per hour] in 1999 to over 95 now,” he said. “Every pitcher on the LSU pitching staff [college baseball’s top-ranked team this season] is 95 to 100. Stresses and loads have exceeded what the body can handle, and they’re doing that at much younger ages, when the body hasn’t developed. Well, guys? Slow down. Let’s teach ’em how to pitch before we teach ’em how to throw hard. That has been kind of backward.”

For the sake of his patients, Meister operates within a bubble. He stopped following sports on television and in the media. He avoids Facebook, Twitter, Instagram, and other social media platforms. If fans are clamoring for an injured star to get back on the field, Meister isn’t going to hear it. “I don’t want anything that I ever read to influence decisions that I make,” he said. “Eliminate the noise.”

That allows Meister to keep the emphasis on relationships with patients. He has more than four thousand contacts saved in his cell phone. “And I can tell you a story for each one of them,” he said. “Whether it’s an agent or a trainer or a former athlete.”

There’s another aspect of Meister’s work that goes old-school. “Anytime from my first day in practice a patient has written me a thank-you note or a card, I’ve saved it,” he said. “Every note. I have them all saved at home. I have several boxes of them.”

Meister’s Arlington clinic has grown from a 1,100-square-foot office staffed with two other employees to a 22,000-square-foot complex that opened in 2015, which he shares with nine partners. “I probably enjoy it more now than I ever have,” he said. “I don’t have to do this anymore; I do this because I enjoy working.”

He also understands how rare opportunities are to treat world-class athletes. “Some of the other [doctors] that have left the game, that inner circle, they’ve kind of disappeared,” Meister said. “And the people I interact with now every day, especially at the pro level, even at the elite college level, they’re friends of mine. So I talk to these people every day, every week. And when you walk away from that, that’s a big piece of it that you lose.”