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Tommy John surgery is reconstruction of your ulnar collateral ligament (UCL) at the inside of your elbow. UCL injuries are common in competitive and professional athletes in overhead throwing sports like baseball, javelin or football. You may have to sit out a season or so, but most people are able to return to play after rehabilitation.
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Tommy John surgery, also known as ulnar collateral ligament (UCL) reconstruction, is a procedure to fix an unstable or torn UCL. Your UCL is a strong band of tissue on the inside of your elbow (the joint where your arm bones meet). In Tommy John surgery, your surgeon reinforces your joint with a healthy tendon from somewhere else in your body. If for some reason your own tendons won’t work, your surgeon may also get one from a donor. Wherever the tendon comes from, it’s called a graft. You surgeon attaches it to your ulna and humerus to act like a new UCL, making your elbow more stable, reducing pain and restoring your range of motion.
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UCL reconstruction is frequently called Tommy John surgery after a Major League Baseball (MLB) pitcher who tore his UCL. He had UCL reconstruction in 1974. Although he had to sit out for a season, Tommy John went back to playing professional baseball after the procedure.
Tommy John surgery treats ulnar collateral ligament injuries. These overuse injuries are most common in people who play sports that involve overhead throwing, like:
Usually, people who play these sports for fun will recover from a UCL injury after rest and conservative treatment. These people don’t need surgery. But for competitive and professional athletes who throw again and again, their injuries get worse over time. These people may need UCL reconstruction (Tommy John surgery) to return to competitive play.
Your provider will evaluate the extent of your UCL injury by:
They’ll also talk with you about the level of sports you play and when you’d like to return to play before deciding if surgery or nonsurgical treatment is the best option for you.
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Before recommending Tommy John surgery, your orthopaedic surgeon will ask you to try nonsurgical treatments. These include:
Your surgeon will tell you what you need to do to get ready for Tommy John surgery. In general, you’ll need:
Tell your provider and surgeon about any medications and over-the-counter (OTC) supplements you take. You may have to stop taking some medications or supplements before your surgery.
Your surgeon will tell you when you should stop eating and drinking the day before your surgery. Most people need to avoid eating and drinking for 12 hours before their UCL reconstruction.
Your surgical team will help you get comfortable on the table. You’ll lie on your back and your arm will be supported. Your anesthesiologist will administer general anesthesia, so you’ll sleep throughout the surgery and won’t feel pain.
To begin, your surgeon may take a look inside your elbow using a technique called elbow arthroscopy. Not everyone needs this. But, if they find other injuries to your elbow joint, they may fix them at the same time as your UCL reconstruction.
Your surgeon will take (harvest) about 6 to 7 inches of tendon from another spot on your body. They usually use the palmaris longus tendon from your forearm, but sometimes use a tendon from the back of your knee near your hamstring.
Next, your surgeon will make an incision on the inside of your elbow. They’ll remove any damaged tissue. Traditionally, the next step is to drill two holes in your ulna and three (in a Y-shaped pattern) in your humerus. These holes form tunnels through which your surgeon threads the harvested ligament. Your surgeon stitches the ligament to itself to make a loop that holds the bones together. Some variations use fewer holes or tunnels, and/or screws to anchor the tendon graft.
If the injury damaged your ulnar nerve, your surgeon may move it outside the cubital tunnel during your Tommy John surgery. This allows you to move your elbow without irritating the nerve.
After testing the strength of the graft, your surgeon closes your muscles and skin with stitches (sutures) and applies a clean dressing. They’ll put your arm in a hard splint that doesn’t allow you to move your elbow. This is called immobilization.
The length of Tommy John surgery (UCL reconstruction) varies. But it usually takes about 60 to 90 minutes.
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After your elbow heals in the hard splint for one to two weeks, you should be able to switch to a hinged brace. This splint hinges at your elbow to allow for limited exercise. But when you’re not doing your exercises, you lock the hinge to allow for rest and healing.
After your surgeon sees you for follow-up about 12 to 16 weeks after the procedure, you can begin a supervised training regimen that involves some (limited!) throwing. As your strength returns, you’ll gradually be able to throw more. Most people return to play in about 12 to 18 months.
The benefits of Tommy John surgery include:
Surgeons say a Tommy John surgery is successful if you return to play at the same level or better. These procedures have a high success rate for professional baseball players, with return-to-play rates of 80% to 95%. But your return to play after Tommy John surgery depends on several factors, including your rehabilitation regimen, your age, your level of play before injury and the type of throwing you do in your sport.
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The risks of Tommy John surgery are like those of other surgical procedures. They include:
Certain health conditions can make recovery from a UCL reconstruction more difficult. Talk to your surgeon about your health history. Tell them if you have:
Your surgeon will tell you what you can expect after your surgery and how you can reduce your chances of experiencing complications.
It takes a long time to recover from a Tommy John surgery. You’ll need at least nine months — probably longer — to rest, recover, strengthen and retrain before returning to sports. For four to six weeks, you’ll wear a hinged brace to slowly increase your range of motion. Your physical therapists and sports medicine team will monitor your progress through rehab and let you know when it’s safe to play again.
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Everyone heals differently. Working with your sports medicine team, you may be able to return to limited practice in six to nine months. Depending on your sport and level of play, it can take up to 18 months for you to rehab and get back to your game.
Call your surgeon or healthcare provider right away if you experience any of the following symptoms after Tommy John surgery:
If you’re a competitive or professional athlete, a UCL injury may be career-ending. But it doesn’t always have to be. When needed, Tommy John surgery can treat UCL injuries and get you back in the game.
Choosing the right surgeon in a hospital that does these procedures regularly is important. So is your commitment to a gradual rehabilitation program. It’s crucial that you don’t return to play until your surgeon says it’s OK. If you go back too soon, you may need more surgeries and even more time away.
From sudden injuries to chronic conditions, Cleveland Clinic’s orthopaedic providers can guide you through testing, treatment and beyond.
Last reviewed on 07/05/2023.
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