Tommy John surgery has profoundly impacted how we treat previously career-ending elbow injuries. As of 2023, over 1,000 professional baseball pitchers have had Tommy John surgery for ulnar collateral ligament (UCL) injuries, with 35.3% of active major-league pitchers having already had the surgery. Learn the role of surgeons in UCL reconstruction, why the surgery is so popular among athletes and what to expect from the procedure.
Tommy John surgery is another name for UCL reconstruction surgery. The UCL lies on the inside of your elbow and supports the joint as you raise and lower your forearm. If this ligament gets torn or injured, Tommy John surgery can restabilize the joint using a piece of tendon from another body part and remove damaged tissue, restoring your range of motion and reducing pain.
In 1974, Major League Baseball player and renowned pitcher Tommy John was the first to undergo this UCL reconstruction surgery. While it was an experimental procedure back then, it proved impressively successful and became the gold standard in treating significant UCL injuries in the following decades. Today, UCL surgery is nicknamed “Tommy John surgery” in honor of the pioneering patient and how it saved his budding baseball career.
You don’t have to be an athlete to injure your elbow joint. Anyone with a significant UCL injury can be eligible for the surgery, whether the injury happened at work, during daily life or through gradual wear and tear. Although Tommy John surgery is synonymous with baseball because of its first success story, the procedure can benefit athletes in numerous fields that frequently use the UCL, including:
If you’ve strained your UCL, you’ll likely feel mild to moderate pain around your inner elbow, notice some swelling around the joint and have a stiff and tender arm when bending it. Strains often respond well to conservative treatment like rest, ice, physical therapy, pain medication and anti-inflammatories. Speak to your primary health care provider if you’re concerned about a UCL strain.
A UCL tear or complete rupture, however, brings about more intense symptoms, such as sudden, severe pain and swelling, inability to use your arm for activities like throwing or lifting and a popping sound or feeling at the moment of injury. Tears often require more specialized treatment and should be evaluated by an orthopedic surgeon for possible surgery.
Medical professionals will walk you through your UCL reconstruction from start to finish and collaborate to provide customized care for your unique needs, goals and preferences. The UCL reconstruction process involves:
First, you’ll talk to your doctor about your symptoms, when the injury occurred and what you were doing at the time. They will then physically examine your elbow joint and sometimes order imaging like X-rays or MRIs to determine the severity and location of the ligament damage. If your doctor decides you need Tommy John surgery, you’ll book a surgery date and receive instructions on preparing for the procedure.
UCL reconstruction is usually outpatient, meaning you can leave the hospital on the same day of your surgery. The procedure can be performed under general or regional anesthesia. Occasionally, medical providers will use a minimally invasive, thin, flexible tube with a camera called an arthroscope to assess the joint for other injuries. They’ll then make an incision about 3 inches long along your inner elbow to access the damaged ligament.
One of the most important techniques in UCL reconstruction surgery is extracting and repurposing tendons. The surgeon will remove a tendon from your wrist, knee or hamstring for your UCL reconstruction. If they use a tendon from your own body, it’s called an autograft. In special cases, surgeons can alternatively use a tendon from a cadaver, called an allograft.
After making the incision along your inner elbow, your surgeon will remove the damaged tissue and use the tendon graft to create a substitute support structure to replace your UCL. The tendon is connected to the ulna (in your forearm) and the humerus (upper arm) bones using one of several methods. After reconstructing the ligament, the surgeon closes the incision with stitches and places a bandage over it.
After the surgery, you’ll spend some time in recovery so medical providers can monitor your condition as the anesthesia wears off. Before you’re discharged, you’ll receive instructions on caring for your elbow and when to follow up with your doctor. Your arm will likely be placed in a brace or splint to stabilize it during the initial healing phase.
Dr. Neal ElAttrache, lead physician for the Los Angeles Dodgers, estimates that 80% of pitchers return to their pre-injury performance level, suggesting high success rates. Tommy John surgery has been performed on pro baseball players over 2,400 times, with more than half of these procedures occurring in the last decade. The number of yearly UCL reconstructions rapidly increases as medical technology improves, success rates climb and specialized methods are developed.
Physical therapy for rehabilitation post-UCL reconstruction surgery typically follows a structured four-phase protocol:
Every patient recovers at their own pace, and rare complications can arise, so Tommy John surgery recovery time varies. Some studies conclude that recovery from UCL reconstruction can take six months, while others note that it can take over a year for athletes to fully return to their pre-injury level of play.
Although UCL reconstruction has a high success rate, Tommy John surgery may come with some potentially adverse outcomes, including:
Research illustrates significantly high patient satisfaction rates of 93.4% at their final follow-up appointment. Major League Baseball players continue to undergo Tommy John surgery as a career-saving move. Looking at the fantastic achievements they’ve amassed after recovering and returning to baseball, it’s clear that on a professional level, UCL surgery was a satisfying success:
Fondren Orthopedic Group has over 50 years of experience providing patient-centric, customized care for a wide variety of conditions and injuries. We’re dedicated to excellence in all we do, from our state-of-the-art medical equipment to our cutting-edge, evidence-based treatment methods. We have a collaborative approach to diagnostics and treatment. Our board-certified, nationally recognized sub-specialized physicians work together to provide nuanced, personalized care to each patient.
As Houston’s largest private practice group, we pride ourselves on staying at the forefront of medical research and technology. The Fondren Orthopedic Research Institute (FORI) is committed to advancing orthopedic research and raising the bar for patient satisfaction. We harness the power of data to accelerate research, drive innovation and enhance the use of evidence-based practices in clinical settings.
Fondren offers expert medical support in Houston, Texas. If you’d like to discuss possible elbow surgery with an industry-leading team of orthopedic surgeons, schedule an appointment or contact our practice today.
