Tommy John Surgery

Tommy John surgery, also called ulnar collateral ligament (UCL) reconstruction surgery, involves the replacement of a torn ulnar collateral ligament with a tendon from elsewhere in the body.

Ulnar Collateral Ligament Anatomy

The UCL, also called medial collateral ligament, is located on the inside of the elbow and connects the ulna bone to the humerus bone.  It is one of the main stabilizing ligaments in the elbow, especially with overhead activities such as throwing and pitching. When this ligament is injured, it can end a professional athlete’s career unless surgery is performed.

Treatment of Ulnar Collateral Ligament Injuries

Your physician will recommend conservative treatment options to treat the symptoms associated with UCL injury unless you are a professional or collegiate athlete. In these cases, if you want to continue in your sport, surgical reconstruction is performed.

Indications of Tommy John Surgery

If conservative treatment options fail to resolve the condition and symptoms persist for 6-12 months, your surgeon may recommend Tommy John surgery.

Tommy John Surgery Procedure

Tommy John surgery repairs the UCL by reconstructing it with a tendon from your own body (autograft) or from a cadaver (allograft). The most frequently used tissue is the palmaris longus tendon in the forearm. The basic steps for UCL reconstruction surgery includes the following:

• The surgery is performed in an operating room under regional or general anesthesia.
• Your surgeon will make an incision over the medial epicondyle area.
• Care is taken to move muscles, tendons, and nerves out of the way.
• The donor tendon is harvested from either the forearm or below the knee.
• Your surgeon drills holes into the ulna and humerus bones.
• The donor tendon is then inserted through the drilled holes in a figure 8 pattern.
• The tendon is attached to the bone surfaces with special sutures.
• The incision is closed and covered with sterile dressings.
• Finally, a splint is applied with the elbow flexed at 90 degrees.

Post-operative Care for Tommy John Surgery

After surgery, your surgeon will give you instructions to follow, depending on the type of repair performed and the surgeon’s preference. Common post-operative guidelines include:

• Elevate your arm above heart level to reduce swelling.
• Wear an immobilizing splint or cast for 1-3 weeks.
• Apply ice packs to the surgical area to reduce swelling.
• Keep the surgical incision clean and dry. Cover the area with plastic wrap when bathing or showering.
• Physical therapy will be ordered for strengthening and stretching exercises after the removal of the splint or cast.
• Professional athletes can expect a strenuous strengthening and range of motion rehabilitation program for 6-12 months before returning to their sport.
• Eating a healthy diet and not smoking will promote healing.

Risks and Complications of Tommy John Surgery

As with any major surgery there are potential risks involved. The complications associated with Tommy John surgery may include:

• Infection
• Limited range of motion
• Nerve damage causing numbness, tingling, burning or loss of feeling in the hand and forearm area
• Cubital tunnel syndrome
• Elbow instability