Tommy John Surgery (UCL Reconstruction) in Dallas, Plano, Frisco, and Wylie TX

Ulnar Collateral Ligament Reconstruction

During Tommy John surgery, orthopedic surgeons will use a graft from one part of your body, or donor to rebuild the torn ulnar collateral ligament. The hamstring or palmaris long is is usually chosen because it most closely resembles the UCL tissue. Once in place, the surgeon will secure the new UCL with sutures, screws, and anchors.

Symptoms of a UCL Injury

It’s common to hear a “pop” sound when the ulnar collateral ligament tears. Once the UCL tears, you most likely won’t be able to use that arm much or throw with it until you receive treatment. Before the ligament tears, the inner area of your elbow might be sore due to the strain on the UCL ligament. Other signs that your UCL has torn are:

• Bruising around the site of the injury
• Weakened grip
• Swelling around the inner part of the elbow and upper forearm
• Tingling in the hand of the arm affected. You may notice tingling in your ring finger and pinky finger.
• Stiffness in your elbow and not being able to extend your arm fully

Why Is It Called Tommy John Surgery?

Tommy John was a Major League Baseball pitcher from 1963 to 1989. He pitched for the Chicago White Sox, Los Angeles Dodgers, Cleveland Indians, California Angels, New York Yankees, and Oakland Athletics. In 1974 while pitching for the LA Dodgers, he tore his ulnar collateral ligament. The team physician, Dr. Frank Jobe, performed the first UCL reconstruction surgery on John in 1974.

As Dr. Jobe began the procedure, he realized that John’s UCL injuries were more severe than he thought. After learning he could not repair the torn UCL, he removed a ligament from John’s wrist and used it to repair the damaged elbow joint.

Tommy John would go on to play 26 seasons in the MLB. His pitching didn’t suffer following the surgery, either. In 1977 he finished second in the CY Young National League race. He retired at 46 years old in 1989.

What Causes the Need for Tommy John Surgery?

Repeated throwing motions can cause the ulnar collateral ligament to become weak over time, which is why UCL injuries occur in baseball players and other throwing athletes. Many throwing athletes, like baseball pitchers, throw overhand. The ulnar collateral ligament stabilizes the athlete’s elbow while they perform this throwing motion. Repetitive stress on the elbow joint from pitching and other throwing sports can eventually cause the UCL to tear.

In recent years, younger athletes have started experiencing UCL tears. As more pressure is placed on young athletes and their seasons become longer and more strenuous, the risk of elbow injuries increases. When young athletes experience these UCL injuries, it’s also called little league elbow.

Who Can Benefit from Tommy John Surgery?

Patients candidates for Tommy John surgery usually have UCL tears that have happened over time and are due to overuse. These overuse injuries are most common in professional athletes and some younger athletes who bend their elbows a lot.

How to Prepare for Tommy John Surgery

Your orthopedic surgeon will go over your procedure at your pre-op appointment. You will most likely be given a list of things to avoid and other pre-surgical tips.

• On the morning of your surgery, wear loose-fitting clothes that are comfortable and easy to remove.
• Do not wear makeup, lotion, deodorant, perfume, cologne, or jewelry.
• Do not eat after midnight the night before your surgical procedure. Clear liquids can be consumed up to two hours before surgery.
• During your pre-op appointment, tell your doctor what medications you’re taking. You may be asked to stop taking certain medications before surgery. For example, NSAIDs can increase your bleeding, so it’s recommended to stop taking them before surgery.
• Make sure you have someone to drive you home following the surgery.
• If you smoke, stop smoking as soon as you can. This can increase your risk of complications during and after the surgery, like wound healing issues and difficulty breathing.

What to Expect During a Tommy John Surgery Procedure

After you’ve been prepped for surgery, your orthopedic surgeon will review the surgical plan. Your anesthesiologist will also visit you, discussing the general anesthesia process with you. It’s important to let them know if you’ve had any complications from anesthesia.

Once you’re in the operating room, you’ll be given your anesthesia either intravenously or through inhalation. A typical ulnar collateral ligament reconstruction will take 60 to 90 minutes.

1. If using your own tissue to reconstruct your UCL, the surgeon will make an incision in your forearm, knee, foot, or behind your thigh to take a portion of the tendon between 15 to 18 centimeters long to use for the UCL reconstruction.
2. After the tendon is harvested, the surgeon will make an incision over the inside of your elbow between three to four inches long.
3. Your doctor will move any muscles, nerves, and tendons out of the way so that he can see the UCL injury.
4. Then, the surgeon will drill holes both above and below the elbow. The tendon graft will be woven through the holes to rebuild the torn UCL. Screws and sutures then secure the graft tendon.
5. The incisions will be closed at the suture site, and a bandage will be placed over the wound. Your elbow is placed in a rigid brace.

Following the procedure, your anesthesia is stopped, and you will be wheeled into recovery. UCL reconstruction is an outpatient procedure, which means you can go home after your surgery.

Is Tommy John Surgery Painful?

All surgeries involve some level of pain. After surgery, you can take anti-inflammatory and over-the-counter medication to reduce swelling. Patients that have had Tommy John surgery usually experience the most pain during physical therapy, but the physical therapist will work with you on ways to keep you comfortable while working on your elbow joint.

If you experience severe pain during therapy, it’s important to let your physical therapist know, as this could indicate inflammation.

How Long Does Tommy John Surgery Take?

Tommy John surgery is an outpatient procedure that takes an hour to an hour and a half.

What to Expect After Tommy John Surgery

After surgery, you can go home once your anesthesia has worn off and your vitals are stable. Following your doctor’s recovery instructions is important once you’re home. Your doctor will usually have you:

• Take your prescribed pain medication as instructed
• Resume normal eating habits
• Ice your elbow three to four times a day in 15 to 20-minute increments

You’ll follow up with your surgeon several days after your procedure and start physical therapy. Following your doctor’s instructions after UCL reconstruction is vital as the tendon graft is extremely fragile.

Tommy John Surgery Recovery Time

The timeline for recovering after Tommy John surgery will differ for everyone, especially for professional baseball players and other athletes. Depending on the extent of your UCL injuries, your recovery timeline may be longer. However, the recovery for Tommy John can typically be broken down into three phases.

1. Following surgery, your arm will be placed in a brace that stabilizes your elbow at a 60 to 90-degree angle. It’s important to continue exercises for your shoulder, biceps, and hand, as this will prevent muscle atrophy.
2. Two weeks after your surgery, you can move your elbow joint. At this point during your recovery, your physical therapy exercises will work towards improving your range of motion. When you’re not using your arm, you can still keep it in the brace.
3. Once your arm comes out of the brace, you should regain your full range of motion and fully extend your arm. Your physical therapy will involve strengthening and flexibility exercises.

Recovery for athletes will usually be similar to the phases above, but it could take them longer to return to their sport. Returning to the professional level might take time, but many athletes return to their professional sport. In a study published by The American Journal of Sports Medicine, 80% of Major League baseball players returned to Major League baseball. That same study also showed pitchers noticed more strength in their pitching arm and threw better.

Risks and Complications of Tommy John Surgery

In addition to the normal risks of any surgery, like infections and anesthesia complications, UCL reconstruction has additional risks.

• Stiffness and/or swelling around the injured UCL
• Tingling, numbness in the hand, and weakness
• The graft has become ruptured or stretched
• A piece or fragment of the bony area inside your elbow has broken off. This is an avulsion fracture of the medial epicondyle
• Numbness or pain around the tendon graft area

What Is the Success Rate of Tommy John Surgery?

Tommy John’s surgery is highly successful, with a success rate of over 90%.

How Long Until You Can Resume Sports After Tommy John Surgery?

Many professional athletes need longer to recover than average due to the strain they put on the elbow and shoulder. Athletes should be able to return to their sport between 12 months to 28 months following their surgery. The study conducted by The American Journal of Sports Medicine referenced above found that 148 Major League pitchers returned to professional baseball following their surgery, with 174 out of the 179 studied returning to either Major or Minor League play.

Tommy John Surgery Cost

Most insurance plans cover the cost of surgery depending on patients plans and deductibles. Knowing the exact amount without discussing it with your insurance provider is difficult. Your cost could be lower depending on the type of healthcare coverage you have.

At SPORT, we are transparent with our patients about the estimated costs of their procedures. We accept multiple forms of insurance, and our services are more affordable than emergency rooms. If you have suffered a sudden injury, we can see you quickly at our Dallas orthopedic urgent care clinic.

Other factors determining cost are the severity of your damaged ligament and your surgeon. At SPORT Orthopedics + Physical Therapy, we have cash pricing options available. To learn more, schedule an appointment with us today.

Contact SPORT Orthopedics + Physical Therapy Today

If your game suffers due to elbow pain, it may be time to call SPORT Orthopedics + Physical Therapy. Our top orthopedic surgeons perform a variety of joint replacements, including knee replacement, hip replacement, and elbow replacement, and are ready to treat you. Whether you’re ready to return to the field or get back to living an everyday, pain-free life, it’s time to make the call. Contact us today at 469-200-2832 or complete the online form.