Tommy John Surgery (Medial Ulnar Collateral Ligament Reconstruction)

Tommy John Surgery repairs elbow ligament damaged by strong, repetitive overhead throwing motions of the arm or dislocation of the elbow. Physicians first performed the surgery in 1974 on baseball pitcher Tommy John.

What You Need To Know About Tommy John Surgery

What is Tommy John Surgery?

The ulna collateral ligament is one of the most frequently injured parts of the elbow. Repetitive motion or overuse of over use of the ligament can cause tears.

Tommy John Surgery (also known as a UCL reconstruction) is a procedure commonly used to repair a torn ulnar collateral ligament. This procedure can improve elbow stability, reduce pain, and support a full range of motion. During this procedure, a surgeon uses a tendon from somewhere else in the body and repurposes it inside the elbow.

Los Angeles Dodgers pitcher Tommy John was the first person to undergo this type of UCL surgery. And his undeniably successful results have caused the surgery to become synonymous with his name. Tommy John Surgery has become a common procedure for pro and college athletes, especially pitchers, in recent years.

The experts at Resurgens Orthopaedics' can help alleviate painful conditions that affect elbow mobility. Book an appointment to see a Hand and Wrist Center expert today!

Why is Tommy John Surgery Performed?

The most common reason for Tommy John Surgery is to repair a torn UCL. Athletes may experience a UCL tear due to overuse or a traumatic physician incident. The UCL connects the upper arm bone (humerus) to the forearm bone (ulna) inside the elbow.

Pitchers frequently experience torn UCL due to repetitive stress from throwing baseballs. The extreme stress on the elbow from throwing makes pitchers highly susceptible to a torn ligament. A person may continue to develop more tears on their UCL and may significantly impair their arm mobility if they do not seek treatment.

How to Prepare for Tommy John Surgery

You may have to stop taking certain medications to prepare for a Tommy John Surgery. Certain medications increase the risk of blood clots and diminish your immune system. The outpatient procedure takes between 60 and 90 minutes. Surgeons administer general anesthesia, and the patient can usually return the same day as their scheduled procedure.

Make sure to have plenty of precooked or easy-to-prepare meals ready at home and multiple sets of comfortable clothes that are easy to remove and wear.

What Happens During Tommy John Surgery?

A surgeon will begin the surgery by harvesting a tendon from the patient's body. The most common tendons used in Tommy John Surgery are the palmaris longus tendon from the forearm, the hamstring tendon, or the big toe extensor tendon. In some rare instances, the tendon will come from an organ donor.

The physician will then access the elbow joint through an incision on the outside of the elbow. They will remove any damaged tissues and move other muscles and tissues out of the way to access the damaged tendon. The surgeon attaches the new tendon by drilling holes in the two bones connecting the UCL: the humerus and ulna. They will graft the new tendon using sutures, buttons, and screws and may use part of the original damaged UCL to reinforce the new one using a figure-eight pattern.

The surgeon will suture the tendon, close the incision, and place the operated elbow in a hard brace for one to two weeks. The patient may begin to practice supervised exercises three to four months later and return to competitive throwing after a total of six to nine months. Complete recovery to pre-injury function takes around 12-18 months following surgery.

Are there Risks Associated with Tommy John Surgery?

Possible risks and complications from Tommy John Surgery include:

  • Infections, hematoma, or issues from the surgical anesthesia

  • Nerve or blood vessel damage

  • Stretching or rupture of graft

  • Difficulties at the graft harvesting site

  • Ulnar nerve irritation from the elbow injury

Post Tommy John Surgery & Recovery

There are three phases of Tommy John Surgery rehabilitation. During the first phase immediately following surgery, a physician will place the operated arm in a brace. A doctor stabilizes the arm at a 60 to 90-degree angle. The brace will promote healing the tissue and reduce inflammation. It is crucial that the patient performs recommended bicep, shoulder, and hand exercises to avoid atrophy.

After two weeks of post-surgery healing, the patient will begin phase two of recovery and begin rehabilitation for their operated elbow joint. Physical therapy will help improve range of motion while the brace will help stabilize the joint. The patient may use a sling while the elbow continues to heal.

After around four to five weeks, the patient should be able to remove their brace and fully extend their arm. The range of motion will still be limited, but after a few months, the patient should have full elbow mobility. The patient will continue physical therapy and focus more on flexibility and strengthening exercises.

Full rehabilitation takes around a year, and athletes wait for at least six to ninth months before returning to competitive throwing. Athletes should also pursue extensive strength, stretching, and conditioning exercises before returning to their sport. Around 85% of athletes can meet their previous level of competition following surgery.

Visit a Resurgens Orthopaedics expert to learn more about Tommy John Surgery and other elbow procedures. Book your appointment now!

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