Tommy John Surgery (Ulnar Collateral Ligament Reconstruction) | PreferredMD
Orthopedic Surgery

Tommy John Surgery (Ulnar Collateral Ligament Reconstruction)

Procedure • By Biraj Patel

When it comes to orthopedic surgeries, one procedure that's often talked about but not fully understood is Tommy John surgery, also known as ulnar collateral ligament reconstruction or UCL reconstruction. In this article, we share what Tommy John surgery is, why it's called by that name, how to prepare for it, what happens during the procedure, what the recovery process looks like, and why people undergo this transformative orthopedic procedure.

What is Tommy John surgery (ulnar collateral ligament reconstruction)?

Tommy John surgery is a surgical procedure primarily used to treat injuries to the ulnar collateral ligament (UCL) in the elbow, most commonly in baseball pitchers, but not exclusive to them. The UCL is a critical ligament that stabilizes the elbow joint, and when it's damaged, it can significantly hinder an athlete's performance or even their daily activities.

Why is it called Tommy John surgery?

The name “Tommy John surgery” is attributed to the renowned pitcher Tommy John, who was the first major league baseball player to undergo this groundbreaking procedure back in 1974. His successful recovery and return to the sport popularized the surgery. While some may wonder why it's named after a baseball player, it serves as a testament to the transformative potential of this operation for athletes and non-athletes alike.

Why people get Tommy John surgery

People opt for Tommy John surgery for various reasons. Baseball pitchers, in particular, undergo this surgery to regain their throwing ability after UCL injuries. Non-athletes with severe UCL injuries may also benefit from this procedure to regain a pain-free and functional elbow. Improved elbow function can enhance the overall quality of life for many individuals.

How to prepare for Tommy John surgery

Preparing for Tommy John surgery is a crucial step that can help ensure a successful outcome and a smoother recovery. 

The first and most important step is to consult with a specialized orthopedic surgeon who has experience in ulnar collateral ligament reconstruction. Choose a surgeon with a strong track record in performing this procedure.

Your surgeon will conduct a comprehensive physical evaluation of your elbow to assess the extent of the UCL damage. They will determine whether surgery is necessary or if alternative treatments are possible. Your surgeon may request preoperative tests, such as blood work and imaging, to ensure that you are in the best possible condition for surgery.

It’s crucial to plan for assistance during your recovery period. You may need help with daily tasks, transportation to and from medical appointments, and emotional support. Ensure that your home is set up for your post-surgery needs. This may include installing handrails, rearranging furniture, and having necessary supplies within easy reach.

If you are scheduled for an overnight stay in the surgery center, pack a bag with essentials like comfortable clothing, toiletries, and any personal items that will make your stay more comfortable.

The Tommy John surgery itself

UCL reconstruction is a complex procedure, and the specifics can vary depending on the surgeon's techniques, the patient's unique circumstances, and the extent of UCL damage. We’ll give you a simplified overview of how UCL reconstruction is typically performed.

The patient is placed under general anesthesia to ensure they are pain-free and unconscious during the surgery. They’re then positioned on the operating table, typically in a way that allows easy access to the affected arm and elbow. The surgical area, including the arm and elbow, is thoroughly sterilized to reduce the risk of infection.

The orthopedic surgeon makes an incision, usually on the inner side of the elbow, to access the damaged UCL. The length and location of the incision may vary depending on the surgeon's preference and the specific case. The surgeon carefully assesses the UCL to determine the extent of the damage. In some cases, the UCL may be partially torn, while in others, it may be completely ruptured. Depending on the assessment, the surgeon will decide whether to repair the existing UCL or replace it with a graft. 

If the UCL is deemed repairable, the surgeon will reattach and reinforce it using sutures or other techniques. But if the UCL is severely damaged, a replacement graft is used. This graft is typically harvested from another part of the patient's own body, such as the forearm, hamstring, or, in some cases, from a donor source. The graft is carefully prepared to match the length and diameter of the original UCL. The graft is secured in place using screws, sutures, or other fixation devices to ensure stability. This is a critical step in ensuring the graft integrates properly with the surrounding tissues.

The incision is closed with stitches, staples, or surgical glue.

After the procedure, the elbow is typically immobilized in a splint or brace to protect the surgical site and promote proper healing.

Tommy John surgery recovery time and care

Recovery from Tommy John surgery is a gradual process. Here's what you can expect.

The first few weeks involve rest and limited movement of the elbow. Physical therapy typically begins shortly after surgery to maintain joint mobility. As healing progresses, your physical therapist will introduce exercises to rebuild strength and flexibility in the elbow.

Athletes can usually return to full activity after about 12–18 months. However, full recovery can take longer, and individual results may vary. It's essential to adhere to your orthopedic surgeon's and physical therapist's guidance to ensure a successful recovery.

Discuss Tommy John surgery with the best orthopedic surgeons on PreferredMD

Tommy John surgery is a remarkable orthopedic procedure that has allowed countless individuals, both athletes and non-athletes, to recover from debilitating UCL injuries. Always remember to consult with the best orthopedic surgeon to discuss your unique situation and treatment options.

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