Tommy John’s Surgery (Ulnar Collateral Ligament Reconstruction)
Tommy John Surgery is another name for UCL reconstruction, so if you’re wondering what causes the need for Tommy John Surgery, look no further than a torn ulnar collateral ligament. Torn UCLs are usually the result of throwing sports, like baseball, tennis, javelin throw, softball or football, for example. However, they can also occur following elbow dislocation or surgery.
Throwers are most at risk for UCL tears, as they put constant stress on the ligament bending and twisting the elbow. The rise of youth sports and increased average velocities are two main attributing factors to increased UCL injuries in younger athletes.
Your UCL could also develop microtears over time. This development causes the ligament to stretch out and fray and leads to ligament ruptures. Once the ligament stretches, it can’t hold the bones anymore while throwing. You also risk tearing your elbow’s ulnar collateral ligament if you fall on an outstretched hand.
After a UCL is torn, it usually won’t heal on its own. There are three main sprain grades when it comes to a torn UCL — first degree, second degree and third degree:
First degree: This issue is painful, but the ligament is not lengthened.
Second degree: The ligament still works but is stretched.
Third degree: The ligament has torn and does not function.
At Aptiva Health, we offer same-day and walk-in appointments for elbow injuries and conditions to evaluate, diagnose, and make the appropriate referral for additional treatment based upon your specific elbow injury or condition. We treat these conditions in our General Medicine, Orthopedics, Sports Medicine, and Physical Therapy departments.
Surgery
Ulnar collateral ligament reconstruction, also known as Tommy John Surgery, is the process of fixing your torn UCL by replacing it with a tendon from somewhere else in your body. It helps alleviate pain and get your elbow back in stable condition so that you can get back to doing the things you love.
Ulnar collateral ligament reconstruction is typically an outpatient procedure that lasts only an hour to an hour and a half. Patients undergo surgery after other rehabilitation exercises, rest or medications fail to yield significant results. Doctors administer general anesthesia before the procedure so that patients won’t feel anything during the surgery. Sometimes doctors can perform arthroscopic UCL reconstruction.
Arthroscopes are tools that have small fiber-optic TV cameras. Doctors may take an arthroscope and insert it into the patient’s elbow, sending images to a computer screen so that they can easily see inside the joint and soft tissues. The doctor may also get rid of any dead or injured tissue and smooth out rough edges during the surgery. However, many times, patients must undergo an open incision Tommy John Surgery to correct their injury.
When your ligament pulls away from your bone, the doctor must replace your damaged UCL with a tendon from somewhere else. They may take a tendon, called a graft, from somewhere else in your body or from a donor. These grafts are usually taken from the hamstring tendon, the tendon in the forearm or the big toe extensor tendon.
The doctor will make an incision, typically three to four inches long, on the inside (or medial side) of the elbow and move tissue and muscles to get to the damage. They’ll then take out damaged tissue and sometimes put what’s left of the original ligament with the new graft to keep the structure super sturdy.
To put the new tendon in, the doctor will drill holes in the upper arm bone, or humerus, and the lower arm bone, the ulna — the bones connected by the UCL. After they drill holes, they’ll thread the graft tendon through the holes using techniques like docking and secure them with sutures, screws or buttons.
UCL Repair with Internal Brace is a newer procedure used to treat UCL tears in younger patients. This surgery is used in younger athletes with clean avulsions. The UCL repair with internal brace is a surgery that involves the use of collagen-coated tape (internal brace) surgically placed at the site of damaged or torn UCL ligaments. This procedure allows for better resistance and a faster patient recovery than traditional UCL reconstruction surgery.
Outcomes
For many athletes who experience UCL tears, the most significant advantage of Tommy John Surgery is the ability to get back in the game. Just as the surgery worked and extended Tommy John’s baseball career, it can also help other athletes continue their sports careers if they follow their doctor’s advice, practice physical therapy and avoid rushing recovery.
In a study of 179 Major League Baseball pitchers who suffered UCL tears and had Tommy John Surgery, 148 players, or 83%, were able to return to play in the Major League. Additionally, 174 pitchers could return to play in the major and minor leagues combined. Only five pitchers, 2.8%, couldn’t return to play in either league.
Tommy John Surgery has encouraging return to sports (RTS) rates (sometimes also referred to as return to play or RTP rates), at more than 80% following the surgery.