Because those undergoing UCL surgery are usually athletes, the success rate is often based on these patients returning to their sports. Many professional baseball players have Tommy John surgery, and 80% to 95% of them are back in action following the procedure.
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Tommy John surgery is a reconstructive procedure to reconstruct a torn UCL (ulnar collateral ligament) in the inner part of the elbow. This important ligament crosses the elbow and connects the upper arm bone, or humerus, with the forearm bone, or ulna, and is activated during overhead throwing motions. The UCL is an important arm ligament activated through overhead throwing motions. UCL injuries mainly impact athletes like baseball and softball pitchers, tennis players, and javelin throwers.
What is Tommy John surgery?
The surgery is named after MLB pitcher Thomas Edward John, Jr. The Los Angeles Dodger was the first person to undergo this procedure in 1974. It was unclear if John would ever pitch another game at the time. However, after a long recovery, he returned to the mound in 1976 and went on to play in the major leagues for over a decade. Since the first Tommy John surgery, more than 1,000 professional pitchers have undergone the procedure.
How do you know if you need Tommy John surgery?
When you hurt your UCL, you’ll feel pain on the inside of your elbow. If you only experience mild discomfort, your UCL injury may be treatable with nonsurgical methods. However, if the pain is severe or you have feelings of instability when throwing, you may benefit from Tommy John surgery.
This procedure involves reconstructing a torn ulnar collateral ligament. Tommy John surgery aims to stabilize the elbow. In some cases, if the ligament is deemed repairable, a complete Tommy John UCL reconstruction is not required. A torn UCL can be repaired surgically with an internal brace. Your doctor will discuss all of your surgical and nonsurgical treatment options with you, and together you will agree on the best path forward.
UCL reconstruction surgery
Ulnar collateral ligament reconstruction surgery, or Tommy John surgery, involves harvesting a tendon from your own body or a cadaver to create a new UCL. Two popular reconstruction methods are the UCL docking technique and the Jobe technique.
In both procedures, the surgeon secures the new tissues in place through tunnels drilled into the bones, creating and attaching a new UCL. Both techniques have similar results.
UCL repair surgery
A newer type of surgery is a UCL repair with an internal brace. During this procedure, the surgeon repairs and reattaches your ligament at the injury site. They then add a collagen fiber tape stitch, called an internal brace, to support the ligament as it heals.
Complications from Tommy John surgery
Like most surgical procedures, Tommy John surgery has risks. Possible complications include:
- Nerve or blood vessel damage
- Rupture of the graft
- Infection
- Stiffness in the arm and/or elbow
Who is a good candidate for Tommy John surgery?
Athletes, especially baseball pitchers, rely on a strong arm for optimal athletic performance. If the repetitive movement of pitching and throwing has resulted in a complete ligament tear (rupture) with elbow instability, they may be ideal candidates for UCL surgery. Younger, healthy individuals tend to have the most success from Tommy John surgery.
UCL surgery is typically recommended after nonsurgical treatment options have failed to alleviate symptoms. Less invasive treatments may include a physical therapy program to strengthen the muscles around your elbow and improve flexibility and stability. The regimen may include various stretching exercises and ice and heat therapies. Your physician may also prescribe nonsteroidal anti-inflammatory drugs (NSAIDs) like naproxen and ibuprofen.
How much does Tommy John surgery cost?
Although Tommy John surgery is an outpatient procedure, it can be expensive. Without insurance coverage, the cost can run anywhere from $10,000 to more than $25,000. That doesn’t include the additional expenses associated with rehabilitation and medication. The good news is that insurance usually covers UCL surgery when it’s required.
How to prepare for UCL surgery
Proper planning upfront for a surgical procedure can lead to better outcomes. While preparing for Tommy John surgery, take time to understand what’s involved, potential risks, and expected outcomes. As your surgery approaches, follow these steps:
- Get a surgical consultation: An orthopedic surgeon specializing in the arm and in athletic injuries can answer all your questions and concerns about your upcoming surgery. They’ll also evaluate your condition and discuss the surgical procedure.
- Evaluate your medications: Your surgeon will ask you to adjust your medication intake or stop them altogether a couple of weeks before your procedure. Certain medications could interfere with anesthesia or increase the risk of complications.
- Follow “pre-hab” exercises: Your care team may start you on a pre-operative physical therapy program to strengthen the surgical site. Adhering to this therapy could lead to better outcomes.
- Don’t go it alone: You’ll experience pain and limited mobility after UCL surgery, and working with an occupational hand therapist is essential to getting the best possible result. For the first few days after surgery, make sure you have a family member or friend who can assist you with day-to-day tasks while you recover. Find a reliable person to drive you to follow-up appointments, pick up prescriptions, and help with household chores.
What happens during Tommy John surgery?
Wear comfortable clothing and bring all required personal, medical, and insurance information. Make sure you have a ride home after your procedure, as you will be unable to drive during your recovery period. Follow all pre-operative instructions regarding eating, drinking, and taking medications.
As you get prepped for anesthesia and surgery, your surgical team will check your vitals and answer any additional questions.
How long does Tommy John surgery take?
The Tommy John surgery process generally takes between one and two hours and you can usually go home the same day.
What is the recovery time for Tommy John surgery?
The initial post-operative recovery time from Tommy John surgery is typically six to eight weeks. During this period, you’ll focus on managing swelling and pain. After that, you’ll begin the UCL rehabilitation process, where you’ll build strength and work toward regaining flexibility and range of motion. Patients may wonder what to expect and what to do following Tommy John surgery. Don’t plan to return to playing sports for a while. Full recovery often takes nine months or longer.
You’ll likely experience pain, stiffness, and swelling immediately following surgery. Your elbow will be secured in a brace at a 60- to 90-degree angle to help the tissues heal and mitigate damage. After around seven to ten days, if everything is healing correctly, you’ll start an early range of motion program and use a removable elbow brace for comfort and support.
Your occupational therapist will typically start you on a therapy regimen to expand your range of motion and gradually strengthen your arm and shoulder within two weeks of your Tommy John surgery. The intensity of the therapy will gradually build to increase your strength and endurance. After about six weeks, you should be able to remove the brace completely.
To maximize your UCL surgery outcome, your physician will provide instructions on how to help speed up your recovery. These steps include the following:
- Avoid strenuous activities that aggravate or strain your elbow and surrounding tissues.
- Don’t overextend or twist your elbow.
- Avoid lifting anything weighing more than two pounds
- Attend all physical therapy sessions.
- Refrain from using alcohol or tobacco products.
- Wear loose, comfortable clothing to avoid compression on the injury site.
- Take medication only as prescribed by your physician.
- Contact your physician immediately if you experience worsening symptoms.
FAQs about Tommy John surgery
There’s no set limit on how many Tommy John surgeries you can have, although that number currently stands at three. Major League Baseball pitcher Jonny Venters returned to the mound after three successful Tommy John surgeries. Of the more than 1,000 MLB pitchers who have undergone the procedure, around 40 have had the surgery twice. However, the recovery time is longer, and the odds of success are lower with each UCL reconstruction.
UCL surgery won’t make your elbow stronger than before the procedure. However, around 80% of professional pitchers perform at the same level they did prior to surgery.
Yes. Patients who undergo Tommy John surgery have a crescent-shaped scar on their inner elbow.
