Medial Ulnar Collateral Ligament Reconstruction (Tommy John Surgery)
What is the Ulnar Collateral Ligament (UCL)?
Thick ligaments on the inner and outer sides of the elbow are known as collateral ligaments, and are important to arm motion. The one on the inside of the elbow is the ulnar collateral ligament (UCL). It runs from the inner side of the humerus (upper arm bone) to the inner side of the ulna (larger of the two forearm bones) at the joint. The UCL stabilizes the elbow during movement such as throwing. UCL injuries range in severity, from inflammation to minor tears to complete ligament tears.
What is Tommy John Surgery?
Tommy John Surgery was named after the baseball pitcher, Tommy John, who tore his elbow ligament due to repetitive overhead throwing motions and underwent surgery to correct it in1974. This type of elbow ligament tear can result from strong, repetitive pitching motion or from an elbow dislocation.
How Long Does UCL or Tommy John Surgery Take?
UCL or Tommy John Surgery is typically an outpatient procedure. This means you can usually return home the same day. It is performed under general anesthesia and may last anywhere from 60 to 90 minutes.
Preparation for UCL Surgery
While a tendon from an organ donor may be used, typically a tendon from the patient’s own body is harvested by the surgeon. The palmaris longus tendon of the forearm is often used, but the surgeon may choose to take a tendon from another area of the hand, wrist or knee. Tendon from one’s own body is the preferred choice as it will bond most easily to the surrounding tissue.
UCL Surgery Procedure
The surgeon accesses the elbow joint through an incision along the inside of the elbow, revealing the injured medial ulnar collateral ligament. By drilling “tunnels” through the humerus (upper arm bone) and ulnar (a lower arm bone) at the points where the damaged ligament normally attaches, the surgeon creates attachment points for the graft. By looping the new tendon through the tunnels in a figure eight pattern, the surgeon is able to anchor it to the bone. Then, the tendon is sutured to itself, which stabilizes the joint, and the incision is closed.
How Long Does an Ulnar Collateral Ligament Take to Heal?
Typically the elbow is immobilized in a hard brace for 1-2 weeks. After that, the surgeon may recommend that the patient transition to a hinged brace to allow for limited motion and exercise. At 3 to 4 months, supervised throwing may be allowed; at 6-9 months, competitive throwing may be allowed. Most athletes regain their pre-injury functional ability about one year to 18 months after surgery.
