Tommy John surgery is a procedure employed to treat a serious elbow injury involving a ligament tear, usually due to high-intensity throwing sports such as baseball. The torn ligament often cannot be stitched back in place and requires reconstruction with a graft, usually taken from the patient’s own body. In Tommy John surgery, the ulnar collateral ligament of the elbow is reconstructed to improve function and stability of the elbow joint.
Anatomy of the UCL
The ulnar collateral ligament (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 in baseball. Forceful throwing or overuse can lead to injury of this ligament.
Some of the common symptoms associated with a UCL injury include:
- Pain on the inner side of the elbow
- Weakened hand grip
- Elbow stiffness
- Inability to fully extend the arm
- Swelling and bruising in the elbow
- Numbness and tingling in the hand, especially the little finger and ring finger
If conservative treatment options such as rest and physical therapy fail to resolve the UCL injury and symptoms persist, your surgeon may recommend Tommy John surgery for UCL reconstruction.
The ulnar collateral ligament is reconstructed with a tendon taken from elsewhere in your body or from a deceased donor. The most frequently used donor tissue is the palmaris longus tendon in the forearm. The steps for UCL reconstruction surgery include 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 at the elbow
- Care is taken to move muscles, tendons, and nerves out of the way
- A new tendon graft is harvested from either the forearm or below the knee
- Your surgeon drills holes into the ulna and humerus bones
- The tendon graft is then inserted through the drilled holes and secured with screws or sutures
- The incision is closed and covered with sterile dressings
- Finally, a splint is applied with the elbow flexed at 90 degrees.
Postoperative Care and Recovery
Common post-operative guidelines after Tommy John surgery include:
- Elevate your arm above heart level to reduce swelling.
- Wear an immobilizing splint or cast for 1-3 weeks to promote healing.
- 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 muscles and improving range of motion post splint removal.
- Eat a healthy diet and refrain from smoking to promote fast healing.
- Refrain from strenuous activities or heavy lifting for at least 3 to 4 months.
- You can resume your normal activities within few months; however, return to sports may take 9 months to a year.
Risks and Complications
As with any major surgery, there are potential risks involved, such as:
- Elbow instability
- Damage to nerves or blood vessels
- Failure of graft requiring revision surgery
An ulnar collateral ligament injury can end a professional athlete’s career unless surgery is performed. Tommy John surgery is the most comprehensive surgical treatment for athletes and youngsters who wish to return to sports after sustaining a severe UCL injury. The surgery addresses persistent elbow pain and instability by replacing the injured tendon with a fresh graft. Tommy John surgery provides athletes the ability to return to strenuous throwing or overhead activities required by their sport.