Tommy John Surgery

The ulna collateral ligament (UCL) rests along the inside of your elbow. It joins your upper arm bone, the humerus, to the lower arm bones, the radius and the ulna. The UCL keeps your arm secure and stable while allowing you to rotate and extend your arm.

Elbow injuries often involve tearing the ulna collateral ligament. Athletes or others who use a repetitive throwing motion may experience tears or deterioration of the UCL. When they’re injured seriously enough, they may find UCL or Tommy John surgery necessary to regain full pain-free movement.

What Is Tommy John Surgery?

Tommy John surgery or ulna collateral ligament surgery restores the stability of your elbow, returns your range of motion and decreases your pain. During the procedure, your orthopedic surgeon replaces the torn ligament with another from somewhere else on your body or with a ligament from a donor.

Former major league baseball pitcher Tommy John was the first individual to undergo this type of surgery and return to play in his sport. He tore his UCL and underwent the approximately year-long recovery process before re-entering full-time play. He went on to play 14 more seasons in a stellar career, becoming the poster child for the procedure that today bears his name.

Who Is at Risk for UCL injuries?

Damage to this tendon may occur if you dislocate your elbow. But while anyone can tear an ulna collateral ligament from an awkward movement or an accident, typically, athletes who throw overhand or use overhead motions are more at risk for UCL injuries than most people. Sports that put participants at risk of an UCL tear include:

• Volleyball
• Swimming
• Tennis
• Basketball
• Baseball
• Softball

What Can You Expect?

Your physician performs a complete examination to ascertain the extent and severity of your UCL injury. Before considering surgery, your specialist may suggest non-surgical treatments such as guided therapy or injections and medications. These options work well if:

• You’re not a competitive athlete
• You have an incomplete tear
• You’re an adolescent whose growth plates may be compromised by surgery

If surgery is necessary, you can expect your orthopedic surgeon to follow some standard steps, deviating where required for your particular case. Most Tommy John surgeries involve these steps:

1. You are sedated, so you’re unconscious during the procedure.
2. Your doctor harvests a ligament from another part of your body, such as your hamstring, forearm, hand, knee or big toe.
3. Making a three-to-four-inch incision on the inside of your elbow, your surgeon carefully moves muscles and tissue out of the way to access the torn ligament.
4. The damaged tissue is removed and the joint is thoroughly cleaned.
5. The doctor drills several holes in your humerus and ulna bones, where the ligament normally attaches.
6. Your surgeon threads the new tendon carefully through these holes, securing them permanently with sutures, usually in a figure-eight pattern.
7. Your orthopedist closes the incision and encases your elbow in a hard cast.

After the surgery, you need to keep the elbow immobilized for two weeks. Your doctor then switches your hard cast to a hinged brace. You may begin physical therapy and exercises at this point. PT helps heal and strengthen your elbow, while increasing its range of motion.

Healing from Tommy John Surgery

Tommy John surgery has become more successful and predictable over time. Stronger sutures and better anchoring techniques have improved the treatment. The critical aspect of UCL surgery to keep in mind is the long recovery time.

Athletes begin carefully supervised throwing around three to four months after the procedure. Competitive throwing begins six to nine months after surgery. Most players experience full pre-injury functionality approximately 12 to 18 months following the surgery.