Ulnar Collateral Ligament Surgery

An ulnar collateral ligament (UCL) autograft surgery, often called “Tommy John Surgery”, is an outpatient procedure that requires harvesting a tissue graft from a tendon in the individual’s own body and reconstructing it to replace the torn ulnar collateral ligament in the individual’s medial elbow.

 

Overview of procedure

The tissue graft from the individual’s body is obtained through an arthroscope procedure where a piece of tendon is taken through several small incisions without affecting the function of that body part. The graft is then placed through small bone tunnels in the humerous (upper arm bone) and ulna (lower arm bone) at the site of the normal UCL to replace the damaged UCL. Any remaining pieces of the ruptured UCL will also be stitched to the graft for added strength.

 

Pre-treatment considerations

• This surgery is recommended for those who have tried conservative measures with physical therapy and are not responding to those non-surgical treatments

• Also recommended for those who want to return to strenuous overhead throwing, such as in baseball

• Must consider age and activity level before recommending this treatment

• If the nerve is injured along with the UCL, scar tissue around the nerve may be removed during surgery

• If muscle/tendon is injured at the same time as the UCL it can be repaired at the same time during surgery

 

Post treatment considerations/recovery

• Outpatient procedure where the patient will go home that day

• Splint at 90 degrees in immobilizer for 10-12 days

• Hinge brace for 1-2 weeks after splint is removed

• Physical therapy program is begun to restore range of motion and strength while also working the muscles of the rest of the body for optimal return

• Approximate time frame to return to sport/activity:

  • 6 months to return to contact sports

  • 8 months to return to overhead throwing or racquet sports (non-pitchers)

  • 12 months (to up to 24 months) to return to pitching in baseball

 

Pros or benefits of treatment

• Restores a loose or ruptured elbow to pre-injury like condition

 

Cons, risks, or possible side effects

• Most common risk or side effect with this surgery is damage to the ulnar nerve

• Risk of infection with surgery

• Risk of hematoma

 

FACT: Tommy John did not invent this procedure. He was a baseball pitcher that was the first to undergo this surgery and return to his sport in 1974 with the LA Dodgers.