Tommy John surgery, also known as ulnar collateral ligament (UCL) reconstruction, is a common procedure primarily performed on athletes whose sports involve repetitive overhead motions, such as baseball pitchers. Town Center Orthopaedics’ (TCO) orthopedic surgeon Dr. Baris Yildirim explains what you need to know in this article and video.
As a hand and upper extremities surgeon who focuses on sports injuries in the arm, Dr. Yildirim specializes in Tommy John surgery at TCO. This procedure has been a game changer for those who otherwise may have ended their sports careers because of torn UCLs. He’s prepared the following questions and answers to help you understand what to expect from the surgery and its recovery.
Tommy John surgery is performed to reconstruct the ulnar collateral ligament (UCL) in the elbow.
“The UCL is a ligament that stabilizes the inside of your elbow and plays a critical role in throwing and activities that put the elbow under a lot of stress,” Dr. Yildirim explains. “The tears are often seen in pitchers, but we also see them in athletes who play tennis, football, wrestling, and javelin throwers.”
When repetitive strain leads to partial or complete tears in the UCL, surgical intervention often becomes necessary to restore stability and function. Before the introduction of Tommy John surgery, these tears were career-ending, as surgeons tried to repair tears that couldn’t hold. The difference with Tommy John surgery, first performed by Dr. Frank Jobe, was that it recreated the ligament rather than trying to repair it. The surgery involves taking a tendon from another part of the body or using a donor tendon to replace the damaged UCL.
The surgery is named after Tommy John, a major league pitcher who underwent the surgery in 1974 for the first time. After the surgery, “he was able to get back to pitching in the major leagues and continue to pitch at a very high level,” Dr. Yildirim shares.
The procedure has evolved since then, with advancements in surgical techniques and rehabilitation protocols contributing to improved athlete outcomes.
How to know if you need Tommy John surgery: According to Dr. Yildirim, UCL injury symptoms can present in different ways. “Sometimes, the athlete will feel a pop with pain and have difficulty throwing. Other times, it can be insidious with pitchers having more chronic elbow pain while throwing and decreased pitching velocity.”
Some may also experience numbness or tingling in their ring or small fingers due to nerve proximity to the UCL.
If a UCL tear is diagnosed, it’s important to know whether it’s a partial or complete tear.
“Partial tears with stable elbows are often treated without surgery with a period of rest, followed by physical therapy and a progressive return to activity focusing on improved throwing mechanics and strength,” says Dr. Yildirim.
On the other hand, complete tears in high-level athletes are often treated with surgery followed by extensive therapy.
During the surgery, the surgeon makes an incision on the inner side of the elbow to access the damaged UCL. Depending on the specific condition of the ligament and the patient’s demands for sport, the surgeon may choose from different techniques to reconstruct it. The most common method involves harvesting a tendon from another part of the patient’s body or using a donor tendon. This harvested tendon is then threaded through holes drilled in the bone to create a new ligament structure, effectively replacing the damaged UCL.
How long does Tommy John surgery take? The surgery is performed under general anesthesia and takes approximately 60-90 minutes.
Recovery is a time-consuming process, but it’s vital for a full recovery. Complete recovery can take anywhere between nine to 18 months, and “it’s dependent on proper rehabilitation and diligent adherence to the protocols,” Dr. Yildirim says.
Recovery involves several phases:
Dr. Yildirim cautions that the key is not to rush through the rehab process. “Without the patient’s willingness to undergo the extensive rehab, it may be wise to even think about not going through the operation because the surgery also comes with risks. However, with good rehab, we can achieve a high rate of return to the sport after these injuries.”
Watch the video for Dr. Yildirim’s complete interview. Then, if you’re interested in learning more about UCL tears and treatment options (including Tommy John surgery), talk to your doctor about what to expect throughout the entire journey to prepare yourself both physically and mentally for what lies ahead.
Town Center Orthopaedics is a Virginia leader in sports injuries, including Tommy John UCL reconstruction and repair treatment. “We have a really great team here to get you back to full recovery, whether it’s with or without surgery,” Dr. Yildirim says. Dr. Yildirim works out of our Ashburn, Fairfax, and Reston locations. Make an appointment today by completing the form or calling (703) 435-6604.
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