Tommy John Surgery (UCL Surgery)

What is Tommy John surgery?

Tommy John surgery is a procedure to repair your ulnar collateral ligament. It’s also known as UCL surgery or UCL reconstruction.

Your ulnar collateral ligament is a strong band of tissue on the inside of your elbow. Ulnar collateral ligament injuries happen when you overuse your elbow for a repetitive motion — especially throwing. They usually affect athletes who do lots of overhead throwing in sports like:

• Baseball
• Softball
• Javelin
• Football
• Tennis and other racket sports

If you play these sports for fun, you can probably recover from a UCL injury with rest and conservative treatment. But you might need surgery if you’re a competitive or professional athlete who throws all the time. You may need UCL reconstruction to preserve your career.

Your surgeon will reinforce your elbow with a healthy tendon from somewhere else in your body. They may get a donor tendon if yours won’t work. Wherever the tendon comes from, it’s called a graft. They’ll attach it to your ulna and humerus to act like a new UCL. This will:

• Make your elbow more stable
• Reduce pain
• Restore your range of motion

You may not need a full ligament reconstruction. In this case, your surgeon may insert a device called an internal brace into your elbow. They’ll do this instead of using a graft.

Why is it called Tommy John surgery?

People call UCL reconstruction Tommy John surgery after a Major League Baseball (MLB) player. Tommy John was a pitcher who tore his ulnar collateral ligament. He had UCL surgery in 1974. After the surgery, he sat out the 1975 season. But John returned to playing professional baseball in 1975. People started referring to UCL reconstruction as Tommy John surgery after his procedure was successful.

How should I prepare for Tommy John surgery?

Your orthopedic surgeon will tell you what you need to do to get ready for Tommy John surgery. In general, you’ll need:

• A physical exam to make sure you’re healthy enough for surgery
• Blood tests
• Imaging tests like an X-ray, a CT scan or an MRI to take pictures of your elbow
• An electrocardiogram to check your heart health
• A dental exam to reduce your risk of developing an infection after surgery

Tell your surgeon about any medications and over-the-counter (OTC) supplements you take. You may have to stop taking some of them 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 ulnar collateral ligament reconstruction.

What happens during Tommy John surgery?

Before the surgery, an anesthesiologist will give you general anesthesia. This will put you to sleep so you won’t feel any pain during the procedure.

Ulnar collateral ligament surgery usually follows these steps:

1. Your surgeon may look inside your elbow with an arthroscopy. This will help them find and repair other injuries while they fix your ligament.
2. If you need a graft, they’ll take 6 to 7 inches of a tendon from somewhere else in your body for it. They’ll usually take another tendon from your forearm. But sometimes, they use one from the back of your knee near your hamstring.
3. They’ll remove any damaged tissue from inside your elbow.
4. Next, they’ll drill two holes in your ulna and three holes in a Y-shaped pattern in your humerus. They’ll thread the new tendon through these holes.
5. They’ll insert the new tendon. They might loop it around itself to hold it in place. They may also use screws to anchor it into your bones. Or they’ll insert the internal brace.
6. They’ll repair other injuries in your elbow. This can include ulnar nerve damage and any other issues they find.
7. They’ll close cuts in your skin with stitches. They’ll put a clean dressing on the surgery site.
8. Last, they’ll put your arm in a hard splint. This will stop your elbow from moving after surgery.

How long does Tommy John surgery take?

Tommy John surgery usually takes 60 to 90 minutes. It can vary depending on how damaged your ligament is and if you have any other injuries.

What are the potential benefits and risks?

The benefits of Tommy John surgery include:

• Most people can resume their sports.
• You may have improved throwing endurance. But you shouldn’t get surgery just to improve your endurance.
• You’re unlikely to need more surgery on the same UCL in the future.

UCL reconstruction surgery is usually very successful. Between 80% to 95% of baseball players return to playing without long-term complications. When you can return to play after Tommy John surgery depends on several factors, including your:

• Age
• How well your body responds to rehab
• Level of play before the injury
• Sport or type of throwing

The surgery can have risks, including:

• Infections at the surgery site
• Ulnar nerve tingling or numbness
• Blood vessel damage
• The new tendon loosening or wearing down

What happens after the surgery?

Your care team will move you to a recovery area after the surgery. They’ll keep an eye on you while you wake up from anesthesia. You can usually go home the same day. But you’ll need someone to drive you home. Make sure to arrange transportation ahead of time.

What is Tommy John surgery recovery time?

It usually takes more than a year to recover completely after Tommy John surgery. Your surgeon will give you a detailed recovery timeline. It might look something like this:

• Wearing a hard splint: You’ll need to wear this for a few weeks after surgery. You won’t be able to move your elbow.
• Wearing a hinged splint: After a month or two, you’ll switch to a hinged splint. It’ll let you safely move your arm for limited exercise and physical therapy. When you’re not doing your exercises, you can lock the hinge. This will hold your elbow in place.
• Resuming light throwing: Your surgeon will check your progress after three to four months. You can slowly resume your usual sport or training. But only if they say it’s OK. Take it easy. Follow your surgeon’s instructions. Don’t throw, work out or use your elbow more than they say is safe.
• Ramping up practice or training: You should be able to resume limited practices six to nine months into your recovery. You may still need to modify how you train or avoid certain workouts. Always follow your surgeon’s instructions.
• Returning to your sport full-time: If you don’t have any setbacks or complications, your surgeon will clear you to return to games or competitions. How long this takes will depend on how quickly you heal. It can also vary depending on the sport you play. It might take 12 to 18 months to get to this point.

When should I call my healthcare provider?

Visit a healthcare provider right away if you experience any of the following symptoms after Tommy John surgery:

• Chest pain
• Shortness of breath
• Fever higher than 102 degrees Fahrenheit (39 degrees Celsius)
• Bleeding
• Signs of infection at your surgery site, like leaking, swelling, discoloration, odor or a feeling of warmth
• New or worsening pain in your elbow, arm or hand
• Severe pain that doesn’t get better after you take pain medication