Tommy John Surgery also called Ulnar Collateral Ligament (UCL) Repair
What is Tommy John Surgery?
Tommy John Surgery, also known as ulnar collateral ligament (UCL) repair is used to treat a torn ligament inside the elbow. Prior to this surgery, pioneered in 1974 by Dr. Frank Jobe, a torn ulnar collateral ligament was a career-ending injury for overhead athletes. The surgical technique of UCL reconstruction has continued to evolve since the first reconstruction on Los Angeles Dodgers pitcher, Tommy John. Primarily used for professional baseball players for years, the surgical procedure is now increasingly required among college athletes and younger, active individuals. Dr. James Mazzara, orthopedic elbow surgeon has extensive experience performing Tommy John surgery for patients in Manchester, South Windsor, Rocky Hill, Glastonbury and surrounding Hartford communities.
What is the UCL (ulnar collateral ligament)?
The ulnar collateral ligament in the elbow is a critical structure that keeps the elbow stable. It is located on the inside of the elbow (medial side, next to the body) and connects the ulna (one of the forearm bones) to the humerus (upper arm bone.) It’s job is to stabilize the elbow, keeping the firm connection of upper arm bone and forearm secure. The UCL can stretch with overuse and in some cases, tear either partially or completely. In these instances, it is no longer able to hold the bones tightly together.
What is done during an ulnar collateral ligament repair?
UCL repair, or Tommy John surgery is designed to restore stability to the elbow, allowing patients to return to athletic and daily activities without elbow pain. The procedure is typically done through open surgery, with an incision on the inside (medial area) of the elbow. Dr. Mazzara will reconstruct the ulnar collateral ligament by replacing it with a tendon graft from somewhere else in the body, usually the forearm, knee, foot or hamstring. This is called an autograft. The old ligament is left in place with the new ligament laid over the top of it.
The new tendon is attached by drilling holes in the two bones originally connected by the UCL: the humerus and the ulna. The graft tendon is threaded through the holes and secured by sutures and screws. There are several techniques of threading the new tendon through the bones; the figure-eight technique and the docking technique. The figure eight technique is what Dr. Jobe originally pioneered, where the graft is weaved through the tunnels of the bone and sutured into place. The docking technique reconstructs the UCL by looping a single continuous graft through the ulna bone tunnels and “docking” the sutured graft ends through the two humeral tunnels. The two ends of the graft are sutured together with a non-absorbable material over a bone bridge.
Are you a candidate for Tommy John surgery?
There are two ways to initiate a consultation with Dr. Mazzara:
You can provide current X-rays and/or MRIs for a clinical case review with Dr. Mazzara.
You can schedule an office consultation with Dr. Mazzara.
Who should have Tommy John Surgery?
Tommy John surgery is popular among professional and college athletes who have experienced an ulnar collateral ligament tear. UCL repair is usually only recommended for extreme elbow instability when other treatments and surgeries have failed. Baseball players used to be the primary recipients of Tommy John Surgery, however more overhead athletes such as gymnasts, racquet players and even younger, adolescent athletes.
How long is the recovery after UCL repair?
Ulnar collateral ligament repair has a high success rate but can take time to heal. The surgical procedure can take about an hour, but the complete rehabilitation process can take a year, sometimes more. Here are some things to expect after Tommy John Surgery:
- Immediately after surgery, patients are placed in a sling and splint to protect the healing tissue and reduce inflammation. Physical therapy can begin right away, focusing on the wrist, fingers and biceps.
- 7-10 days after surgery, Dr. Mazzara will see the patient and remove any sutures and check on the healing of the graft. Most patients can begin to move the elbow joint at this time and may wear a hinged brace that can be set at different angles when not exercising. Physical therapy at this stage focuses on gradually increasing your range of motion in the elbow.
- In about 30 days following surgery, patients should be able to fully extend the elbow and may discontinue wearing the brace. Continued physical therapy will work on range of motion and slowly regaining strength in the joint.
- For throwing athletes, a program may begin in about 4 months.
- Depending on the healing process, throwing athletes can return to full activities anywhere from 6-12 months.
For more information on ulnar collateral ligament repair or Tommy John Surgery for UCL reconstruction, please contact the offices of Dr. James Mazzara, orthopedic elbow surgeon, treating patients in Manchester, South Windsor, Rocky Hill, Glastonbury and surrounding Hartford communities.