Tommy John Surgery

Tommy John Surgery, also known as ulnar collateral ligament (UCL) reconstruction, is designed to repair the damaged elbow ligament commonly used in throwing sports. The ulnar collateral ligament is crucial for stabilizing the elbow during throwing motions and can deteriorate over time due to repetitive use. The main goal of Tommy John surgery is to restore elbow stability, reduce pain, and enable a return to physical activity.  

What is Tommy John Surgery? 

Tommy John surgery is named after a baseball player who first underwent the procedure and returned to professional play. The surgery involves replacing the damaged ligament with a tendon from another part of the body or a donor, allowing for a return to regular motion and performance.  

The UCL, sometimes known as the medial collateral ligament, connects the humerus to the ulna at the elbow joint. Three bands make up the UCL in a sort of triangle that provides stability as the elbow moves through its range of motion. As an outpatient procedure, most patients return home after a relatively short one- to two-hour surgery followed by several weeks of physical therapy to help restore strength and stability. 

What is a Tommy John Surgery Procedure Like? 

To start the procedure, the patient is placed on their back with their arm raised and compressed to limit blood flow. A replacement tendon is then harvested from the patient (autograft) or can come from a cadaver or donor (allograft). A standard option for the tendon graft is the palmaris longus tendon from the wrist. This tendon does not impact wrist or forearm movement, and in fact, some patients lack the tendon altogether. If this is not an option, the tendon may be harvested from another forearm tendon, a tendon from the knee or hamstring, a big toe tendon, or part of the Achilles tendon.  

The procedure begins with a three-inch incision centered over the UCL on the inside of the elbow. Soft tissue is then carefully dissected and held apart with retractors along with any nerves in the way. At this point, the surgeon carefully splits the flexor muscles to reach the joint capsule where the UCL is split along the fibers to access the joint.  

Commonly, surgeons use a figure eight method in which bone tunnels are drilled to create a passageway for the graft tendon to attach. One hole is drilled perpendicular to the ulna, while three are drilled into the humerus, meeting in the middle. This allows the tendon to be fed through the ulna, into the humerus, then wrapped around, and back out through the humerus tunnel. This method creates a strong attachment that will become permanent as it heals.  

Variations do exist, including some in which the tendon is held in place with permanent sutures or screws. Finally, the muscles and skin are closed, and a dressing is applied to complete the procedure

. 

What is the Recovery Time After Torn Labrum Surgery? 

Recovery from Tommy John Surgery typically involves immobilization using a splint for about ten days, with any non-absorbable sutures also being removed around this time frame. In some cases, patients may be required to wear a hinged joint brace to keep their elbow stable during the recovery period.  

Physical therapy is critical for proper recovery and should not be taken lightly. With careful adherence to the physician’s physical therapy recommendations, patients can expect to regain a regular range of motion within two months. Generally, patients can begin careful, sport-specific strength training in four months, with throwing practice achievable within six months. Patients can expect a full recovery in nine months to a year with continued strength training and rehabilitation.  

Tommy John Surgery has a high success rate, with most athletes returning to their regular activity level within a year of the surgery. Those who have had the procedure have reported improved performance, though some of this may be attributed to increased strength training, improved understanding of throwing mechanics, and restored elbow stability.  

Are There Any Risks Associated with Tommy John Surgery? 

While Tommy John Surgery is generally successful, it carries risks like any surgical procedure. These include: 

• Infection, though rare, can occur as foreign surgical instruments are inserted into the joint.  
• Nerve damage is possible if the instruments used during surgery affect nearby nerves. 
• Graft failure is one potential risk, leading to recurrent instability or pain in the elbow.  
• Stiffness or loss of mobility are rare, but some patients may experience stiffness or reduced mobility in the weeks following surgery. Physical therapy can often help reduce these side effects.  

Although serious complications are uncommon, if you experience severe side effects like excessive bleeding or debilitating pain, consult your doctor immediately.  

Frequently Asked Questions About Tommy John Surgery 

What is the success rate of Tommy John Surgery? 

Tommy John Surgery boasts a high success rate, with most athletes returning to their previous level of competition or higher. Success depends on various factors, including the severity of the injury, the athlete’s adherence to rehabilitation, and the surgeon’s expertise. 

How does Tommy John Surgery compare to other treatment options? 

Compared to nonsurgical treatments such as rest, physical therapy, and anti-inflammatory medications, Tommy John surgery offers a more definitive solution for severe UCL tears, especially for athletes who require high-level elbow stability. Non-surgical options may relieve minor tears or partial injuries but often do not restore the functionality and strength needed for competitive sports. 

Who is a candidate for Tommy John Surgery? 

Candidates for Tommy John Surgery typically include athletes, including baseball pitchers and javelin throwers who have suffered a complete UCL tear or severe partial tear that impairs their ability to perform. Non-athletes with similar injuries significantly affecting daily activities or work-related tasks may also be considered for surgery.  

Can any surgeon perform Tommy John Surgery? 

Tommy John surgery requires specialized training and experience in orthopedic sports medicine. Not all surgeons are qualified to perform this procedure. Patients should seek out board-certified orthopedic surgeons with specific expertise in elbow surgeries and a proven record of successful outcomes in UCL reconstructions. Our orthopedic surgeons at New York Orthopedics are highly specialized in this area and boast countless procedures across the practice. Contact us today if you’d like to schedule an appointment or for more information. 

NY Orthopedics Shoulder Surgery Specialists 

• STEPHEN J. NICHOLAS, M.D. 
• STEVEN J. LEE, M.D. 
• BENJAMIN B. BEDFORD, M.D. 
• SERGAI N. DELAMORA, M.D. 
• SAMEH ELGUIZAOUI, M.D. 
• GREGORY GALANO, M.D. 
• MATTHEW GOTLIN, M.D. 
• MATTHEW (TEO) MENDEZ-ZFASS, M.D. 
• NICHOLAS A. WESSLING, M.D. 
• JOHN L. XETHALIS, M.D. 

NY Orthopedics has multiple sports medicine offices in New York City, including Manhattan, Brooklyn, and Staten Island, as well as the surrounding counties, including Nassau, Westchester, and Rockland. NY Orthopedics surgeons are also well-versed in addressing issues with the knees, hips, feet, and shoulders. Contact us today to learn more about our services or make an appointment!