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.
