Tommy John surgery is a common term for ulnar collateral ligament (UCL) surgery, which is an operation on the elbow joint. It was named after baseball pitcher Tommy John, who underwent the first of these procedures in 1974.

Tommy John surgery 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 Current Reviews in Musculoskeletal Medicine found that the procedure has a low complication rate and a high return-to-play rate of 80–95%.

Despite the high success rate, some people who undergo the surgery find that it results in some negative effects on pitching performance. Approximately 20% of Major League Baseball (MLB) pitchers cannot return to their pre-injury level of play following recovery, which may take 12–18 months.

Read more to learn about what Tommy John surgery is, who needs it, and the success rates.

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This surgical procedure dates back to 1974 when Dr. Frank Jobe performed it on MLB pitcher Tommy John.

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.

Approximately 26% of MBL pitchers undergo Tommy John surgery during their pitching career.

Some people with an injury to the UCL need Tommy John surgery. The long-term buildup of microtrauma usually causes the injury, but in some cases, a sudden rupture may be responsible.

These injuries lead to pain and a reduction in pitching performance, which may take the form of decreased accuracy, velocity, and strength.

The criteria that determine whether someone needs the surgery include having a complete tear in the UCL or a stretched UCL and not achieving relief with nonsurgical treatments. An individual with a low or medium grade partial tear of the ligament will often respond to a combination of rest and nonsurgical treatments, such as:

  • 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 important soft tissue stabilizer for the elbow joint during overhead throwing.

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 follows:

  • 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 12–18 months for MLB pitchers. This time frame may mean that a player has to miss one or two competitive seasons. However, this lengthy recovery is necessary for the maturation of the graft.

Doctors view Tommy John surgery as a procedure with very good outcomes. It has return-to-play rates in the range of 80–95%.

However, after undergoing Tommy John surgery, about 20% of MLB pitchers cannot attain the same level of play. This is despite modern technologies that have decreased complication rates and increased return-to-sport rates.

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 1–7%.

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 2020 study, prior to the advent of Tommy John surgery, a tear in the UCL ended a person’s baseball career.

Complications are rare, but they may include:

  • rupture
  • stiffness
  • pain
  • weakness
  • 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 include having a complete tear in the UCL or a stretched UCL that is not responding to nonsurgical treatment.

The benefits of the surgery stem from the fact that it reconstructs the UCL, which is vitally necessary for elbow stability. This restoration of stability has enabled many people who have undergone the surgery to return to pitching.