This spring, there were a lot of questions surrounded Cardinals starting pitcher Chris Carpenter.</p><p>Carpenter, the 2005 Cy Young Award winner, had helped the Cardinals win the 2006 World Series. But he made just four starts in 2007 and &rsquo;08 combined. After undergoing Tommy John surgery in 2007, he missed most of 2008 before returning to the mound. But that comeback was cut short by a nerve problem in the back of his right shoulder.</p><p>&ldquo;I&rsquo;m confident in the way that I feel,&rdquo; Carpenter told reporters in March. &ldquo;I&rsquo;m confident that I&rsquo;m going to be fine and I&rsquo;m going to go out and pitch and be successful just like I always have. But after so many ups and downs in the last two years, there&rsquo;s at times some doubt.&rdquo;</p><p>Not any more. Carpenter is a Cy Young contender again after compiling a 17-4 record with a 2.24 ERA. He&rsquo;s a big reason why the Cardinals were back in the playoffs, and he&rsquo;s among a number of players who made the postseason after undergoing Tommy John surgery.</p><p>The list includes the Yankees&rsquo; A.J. Burnett, the Twins&rsquo; Carl Pavano and the Red Sox&rsquo;s Billy Wagner.</p><p>About 75 major-league players had undergone the surgery, including the Royals&rsquo; Joakim Soria and Bruce Chen. Many, like Soria, come back better than ever. But in the early 1970s, an injured arm was a career killer.</p><p>When John&rsquo;s left elbow gave out 35 years ago, he asked orthopedic surgeon Frank Jobe to help salvage his career. Jobe took on the challenge, but it was no easy task.</p><p>&ldquo;I was nervous because we didn&rsquo;t know what we were doing,&rdquo; Jobe recalled in a phone interview. </p><p>Of course, Jobe was basically inventing the surgery, so he couldn&rsquo;t guarantee that it would be successful.</p><p>&ldquo;John talked it over with his wife and his father,&rdquo; Jobe said, &ldquo;and came back and said, &lsquo;Let&rsquo;s do it.&rsquo;.&rdquo; He said, &lsquo;This is what I want to do because I don&rsquo;t want to quit pitching. I can&rsquo;t earn this much money in Terre Haute, Ind.&rsquo;&ensp;&rdquo;</p><p>&bull;&bull;&bull;</p><p>Tommy John surgery sounds more akin to Dr. Frankenstein than baseball.</p><p>The ulnar collateral ligament (UCL) connects the humerus bone (upper arm) to the ulna (a forearm bone). If the UCL is damaged, a surgeon will use a patient&rsquo;s healthy tendon &mdash; Chen&rsquo;s was taken from his left wrist &mdash; to replace the ligament.</p><p>Drilling holes near the joint in the humerus and ulna, the surgeon attaches the tendon by looping it through the holes in a figure-eight pattern. It sounds simple and it usually is; surgery often takes about an hour.</p><p>The thing is a ligament connects bones, but a tendon attaches muscle to a bone.</p><p>&ldquo;The elbow is basically dead tissue,&rdquo; said James Andrews, the famed orthopedic surgeon in Birmingham, Ala., who has done nearly 500 operations in the last three years alone. &ldquo;It&rsquo;s not living tissue, so Mother Nature has to come in and remodel it. It has to develop a blood supply.</p><p>&ldquo;It becomes a remodeled living substance, so it has to go through a whole regeneration process. That&rsquo;s why you can&rsquo;t really start throwing until four months. You have to go through minimal steps of progression to gradually apply the stress, so it learns to be a ligament.&rdquo;</p><p>For a week or so, the elbow is in a hard brace and by the third week, the patient can start performing such exciting activities as combing his hair.</p><p>By the fourth month, a pitcher builds slowly, going from flat-ground throwing to tossing 60 feet without a mound to throwing from the mound at low velocity.