Tommy John surgery is a common term for ulnar collateral ligament (UCL) surgery, which is an operation on the elbow joint. It involves taking a ligament from another part of the body and using it to reconstruct a torn UCL.
This ligament is the most important soft tissue stabilizer for the elbow during a baseball pitcher’s overhead throwing motion. When it tears, it can cause significant problems.
A 2020 study in the journal
Despite the high success rate, some people who undergo the surgery find that it results in some negative effects on pitching performance. Approximately
Read more to learn about what Tommy John surgery is, who needs it, and the success rates.
This surgical procedure dates back to
It initially involved replacing or reconstructing the torn UCL at the elbow with a ligament from the wrist. The replacement ligament is called a graft.
Over the years, surgeons have modified the procedure in various ways. Sometimes, using grafts from other parts of the body can lead to better outcomes.
Some people with an injury to the UCL need Tommy John surgery. The long-term buildup of microtrauma
These injuries lead to pain and a reduction in pitching performance, which may take the form of decreased accuracy, velocity, and strength.
- taking anti-inflammatory medications
- icing the affected area
- doing range-of-motion exercises for the muscles that bend the elbow and turn the forearm palm up
- wearing a brace or splint during sleep
The UCL is an
As the surgery reconstructs this torn ligament, it reduces pain and restores stability and range of motion. These effects often reinstate function to the extent that baseball pitchers may return to competitive sports.
The exact time to recover will vary among individuals. However, rehabilitation after surgery is typically as
- Phase one (weeks 1–3): During the first week, doctors put the elbow in a device that keeps it immobile. Afterward, a person may do gentle range-of-motion exercises with a hinged brace.
- Phase two (weeks 4–8): The range-of-motion exercises continue, but the rehabilitative focus is on restoring strength. This involves exercises using weights to strengthen the muscles that stabilize the elbow, shoulder joints, and shoulder blade. A person will start with 1-pound (lb) weights and increase these by 1 lb each week.
- Phase three (weeks 9–13): The primary focus is on increasing flexibility. This entails activities such as manual resistance exercises and drills involving changing stabilization. A sports-specific program begins at week 12.
- Phase four (weeks 14–26): The main focus is on restoring throwing performance. A person will begin with short-toss throws and gradually advance to long-toss throws. In the final weeks, the program progresses to game simulation that includes throwing from the mound.
The recovery time before a baseball player can return to the game may be as long as
Doctors view Tommy John surgery as a procedure with very good outcomes. It has return-to-play rates in the range of
However, after undergoing Tommy John surgery, about
Some data suggest that the surgery affects pitching performance by leading to:
- reduced elbow extension, or straightening out, after ball release
- medialization of sinker, fastball, and curveball, which means that these pitches travel closer to a pitcher’s midline than intended
- increased earned run average
- increased walks plus hits per inning pitched
The rate of revisions — which is when a surgeon needs to operate again to correct the existing graft — is currently low, in the range of
The main benefit of Tommy John surgery is the restoration of a person’s ability to resume their role as a baseball pitcher. According to a
- ulnar nerve symptoms
Tommy John surgery involves reconstructing the UCL by grafting a ligament from another part of the body. The criteria for needing the surgery
The benefits of the surgery stem from the fact that it reconstructs the UCL, which is