Dr. Adolph Lombardi Jr.
Hip, Knee
Tommy John Surgery
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Are you in need of orthopedic treatment to repair damage to your elbow? Tommy John Surgery—also known as Ulnar Collateral Ligament (UCL) Reconstruction—may be what you need. In this blog post, we’ll break down what Tommy John surgery is all about so that you get the most out of your recovery and return safely to activities you enjoy.
Book a consultation with JIS Orthopedics to see if Tommy John surgery is the right treatment for you. Our surgeons can be found in New Albany and St. Clairsville, Ohio.
What is Tommy John Surgery?
Tommy John surgery is a surgical procedure used to fix an unstable or torn UCL. The UCL is found on the inside of your elbow and connects the upper arm bone, or humerus, to the ulnar, one of the forearm bones. If the UCL becomes unstable or torn, the surgeon can reinforce the elbow joint with a healthy tendon. The tendon graft will either be taken from another part of your body or a donor.
The tendon graft is attached to the humerus and the ulnar to strengthen and stabilize the joint. It will also help to reduce pain and restore range of motion.
Tommy John surgery got its name from a Major League Baseball (MLB) pitcher. He had torn his UCL and underwent UCL reconstruction in 1974.
Who is a Candidate for Tommy John Surgery?
Professional athletes with UCL injuries may be good candidates for Tommy John surgery. These types of injuries are usually caused by overuse in those who participate in throwing sports. They may include the following:
- Softball or baseball pitchers
- Javelin throwers
- Football throwers
- Tennis players and others who participate in racquet sports.
Those who play these sports for fun usually recover with rest and conservative treatment. Professional athletes, on the other hand, usually have a higher play load, and the extent of injury can worsen over time and require UCL reconstruction.
How to Prepare for Tommy John Surgery
You will need to follow all your surgeon’s instructions to prepare for Tommy John surgery. Preparations may include the following:
- A physical exam
- Blood tests
- An electrocardiogram
You will also need to tell your surgeon about any medications you are taking. Those used to thin the blood will likely be stopped. There will also be a period when you will need to stop eating or drinking. It is usually around 12 hours before surgery.
The Tommy John Surgery Procedure
The following is how the Tommy John surgical procedure is likely to be performed:
Step 1: Pre-Surgery Preparation
Your surgical team will assist you in getting comfortable on the operating table. You’ll be positioned on your back with proper arm support. The anesthesiologist will administer general anesthesia to ensure you remain asleep throughout the surgery and don’t experience pain.
Step 2: Elbow Arthroscopy (If Needed)
If necessary, your surgeon may perform elbow arthroscopy to examine your elbow joint. Additional repairs for any other elbow injuries, if found, will be addressed simultaneously with the UCL reconstruction.
Step 3: Tendon Harvesting
Your surgeon will harvest approximately 6 to 7 inches of tendon from another area of your body. Typically, the palmaris longus tendon from your forearm is used, but occasionally, a tendon from the back of your knee near your hamstring might be utilized.
Step 4: Surgical Procedure
An incision will be made on the inside of your elbow. Then, any damaged tissue will be removed. Traditionally, holes are drilled in the ulna (2 holes) and humerus (3 holes in a Y-shaped pattern) to create tunnels.
The harvested ligament will be threaded through these tunnels. The surgeon will stitch the ligament to itself, forming a loop that holds the bones together. Some variations may use fewer holes or tunnels and potentially include screws to anchor the tendon graft.
Step 5: Ulnar Nerve Considerations (If Needed)
If the injury has affected your ulnar nerve, the surgeon may reposition it outside the cubital tunnel during the surgery to prevent nerve irritation.
Step 6: Graft Strength Testing
The strength of the graft will be tested to ensure its stability.
Step 7: Closure and Immobilization
Your surgeon will close your muscles and skin using stitches (sutures). A clean dressing will be applied to the surgical site. Your arm will then be placed in a hard splint to immobilize your elbow and prevent movement. This is known as immobilization.
What Happens After Tommy John Surgery?
Your road to recovery may follow these steps:
- Your elbow will be put in a hard splint for 1 or 2 weeks while your elbow heals.
- Your arm will then be put in a hinged splint to allow some exercise.
- After 12 to 16 weeks, you may be allowed to perform supervised training.
- You will likely be able to return to play after 12-18 months.
What Are the Benefits of Tommy John Surgery?
You may experience the following benefits after Tommy John surgery:
- You will likely be able to return to the sport you love after rehabilitation.
- You may experience an improvement in throwing endurance. However, you shouldn’t get Tommy John surgery solely for this reason.
- Surgery usually resolves the issue without needing revision surgery.
Recovery from Tommy John Surgery
Rehabilitation following Tommy John surgery typically spans a year, with some athletes requiring up to two years to fully regain their previous level of performance. It’s worth noting that not all UCL surgeries demand such extended rehabilitation periods.
The rehabilitation process should be closely overseen by your physician, physical therapist, and sports medicine team and often adheres to a three-phase structure:
Phase I (Immediate Post-Surgery)
- Wear an elbow immobilizing splint for 7 to 10 days.
- Initiate gentle range-of-motion exercises for the wrist, hand, and shoulder.
- Gradually regain full elbow joint motion with the aid of a range-of-motion brace.
- Engage in arm and shoulder strengthening exercises.
- Integrate total-body conditioning exercises.
Phase II (Beginning at Approximately 6 Weeks Post-Surgery)
- Most patients can commence elbow-strengthening exercises.
- For the following 4 months, it’s generally recommended to avoid activities that place excessive stress on the graft.
Phase III (Final Rehabilitation Phase with Surgeon's Approval)
- Around 4 to 5 months after surgery, athletes may initiate light ball tossing without a wind-up motion.
- After 6 months, athletes can start using an easy wind-up motion when throwing.
- At 7 months, baseball pitchers may return to the mound.
- If pain-free and having fully regained normal strength and range of motion after 9 months, pitchers may participate in competitive throwing.
Outlook After Tommy John Surgery
It is well recognized that most athletes will be able to return to the same levels of better after Tommy John surgery. It has been observed that around 80% to 95% of professional baseball players who have Tommy John Surgery can return to playing baseball. The following factors will help determine your outlook:
- Your age
- Your previous level of play
- The type of throwing you perform
- Your rehabilitation program
Book a Consultation Today
If you would like to speak to a qualified orthopedic surgeon, book an appointment with JIS Orthopedics. Our surgeons will be able to determine the best form of treatment according to your injury and rehabilitation requirements. Contact our office in New Albany or St. Clairsville, OH today!
Medically reviewed by AJ Julka, MD
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