UCL Injuries (Tommy John Procedure)

The ulnar collateral ligament is most often injured by repeated stress from overhead movement, usually when playing sports.

These injuries can be treated using a non-surgical approach or surgically, depending on their severity and how well the patient responds to non-invasive treatment, such as rest, anti-inflammatory medication, physical therapy, and bracing.

If they have to undergo surgery, they may be a good candidate for a UCL reconstruction, also known as the Tommy John procedure. Tommy John was a pitcher who played Major League Baseball.

During the surgery, the torn ulnar collateral ligament is replaced with a tendon elsewhere in the body.

How Is the Tommy John Procedure for UCL Injuries Carried Out?

The Tommy John procedure is performed on an outpatient basis, which means the patient can return home the same day. It is performed under general anesthesia and can last from 60 to 90 minutes. The tendon used to replace the torn ligament is known as a graft. It can be collected from various parts of the patient’s body or a donor. A graft is generally taken from one of the following tendons:

• palmaris longus tendon
• big toe extensor tendon
• hamstring tendon in the thigh

To access the elbow joint, a 3-inch incision will be made on the outside of the elbow. Once the muscles and other tissues are moved out of the way, the orthopedic surgeon can assess the damage. Any injured tissues will then be removed. The surgeon may attach the remnants of the original ligament to the graft to reinforce the structure. The surgeon will drill holes in the two bones connected by the UCL to attach the new tendon, namely the upper arm bone and the lower arm bone. Subsequently, the graft is threaded through the holes and secured by sutures, buttons, or screws.

The goal of the surgery is to:

• stabilize the elbow
• reduce or eliminate pain
• restore stability and range of motion

Like most surgical procedures, the Tommy John procedure implies risks such as infection and allergic reactions to anesthesia. The complications the patient can experience include nerve or blood vessel damage. The damage may lead to temporary or permanent numbness or weakness. However, to make sure the risk of coming to struggle with these risks and complications is minimal, the patient should do their research and choose a reputable, experienced orthopedic surgeon.

Recovery After UCL Reconstruction

The rehabilitation after a Tommy John procedure usually involves three phases. The length of each varies from patient to patient, depending on how fast the tissue is healing.

• Immediately after the surgery, the elbow is secured in a brace at a 90-degree angle. The main goal is to protect the healing tissue. The patient can start physical therapy right away, focusing on the wrist, fingers, and shoulder to avoid muscle atrophy.
• One to two weeks after the surgery, they can start moving their elbow. The surgeon may put the patient in a hinged brace that can be locked at a certain angle when not exercising. At this stage, physical therapy focuses on gradually increasing the range of motion.
• By the end of the first month, the patient will be able to completely extend their elbow and stop wearing the brace. If they engage in physical therapy regularly, most patients regain their normal range of motion in the elbow 2 to 4 months after the surgery.

If the patient is an athlete, they may need a longer recovery before they can return to playing sports. In most cases, a throwing athlete can gradually return to throwing between 6 and 9 months after a Tommy John procedure.

Frequently Asked Questions