From the Guidelines
Tommy John surgery is recommended for patients with a torn ulnar collateral ligament (UCL) who have failed conservative treatments, as it has a high success rate of approximately 80-90% in returning athletes to their previous level of competition 1.
Introduction to Tommy John Surgery
Tommy John surgery, formally known as UCL reconstruction, is a procedure that repairs a torn ligament inside the elbow. This surgery is commonly performed on athletes, particularly baseball pitchers, who have damaged their UCL due to repetitive throwing motions.
Diagnosis and Imaging
The diagnosis of a torn UCL is typically made using a combination of physical examination, imaging studies such as radiographs and MRI, and sometimes ultrasound 1. Radiographs are beneficial as the initial imaging for chronic elbow pain and may show intra-articular bodies, heterotopic ossification, osteochondral lesion, soft tissue calcification, occult fracture, or osteoarthritis.
Surgical Procedure
During the procedure, a surgeon replaces the damaged ligament with a tendon harvested from elsewhere in the patient's body (typically the forearm, hamstring, or palmaris longus tendon) or from a donor.
Recovery and Rehabilitation
Recovery from Tommy John surgery typically takes 12-18 months and involves a structured rehabilitation program with progressive strengthening exercises.
Key Points to Consider
- The success rate of Tommy John surgery is high, with approximately 80-90% of athletes returning to their previous level of competition 1.
- Conservative treatments like rest, physical therapy, and anti-inflammatory medications should be tried before considering surgery 1.
- Imaging studies such as radiographs and MRI are important for diagnosing a torn UCL and planning the surgical procedure 1.
- Ultrasound can be used to evaluate the UCL and other elbow structures, but its accuracy may vary depending on the specific condition being evaluated 1.
From the Research
Overview of Tommy John Surgery
Tommy John surgery, also known as ulnar collateral ligament reconstruction (UCLR), is a surgical procedure used to repair a torn ulnar collateral ligament (UCL) in the elbow. The UCL is a critical ligament that provides stability to the elbow joint, and injuries to this ligament are common among overhead athletes, such as baseball pitchers.
Indications and Techniques
- UCLR is typically indicated for athletes who have suffered a UCL injury and have not responded to non-operative treatment 2.
- Various techniques are used for UCLR, including the figure-of-eight and docking techniques, which have been shown to provide high levels of return to sport for overhead athletes 3.
- The choice of graft for UCLR includes ipsilateral palmaris longus tendon autograft, gracilis or semitendinosus autograft, and allograft 2.
Outcomes and Complications
- Studies have reported excellent outcomes for UCLR, with a high proportion of athletes returning to their previous level of play 2, 3, 4.
- Complications of UCLR are rare, but can include graft rerupture or attenuation, ulnar nerve symptoms, stiffness, pain, and/or weakness leading to decreased performance 2.
- Transient ulnar neuritis is the most common complication following UCLR 4.
Rehabilitation Protocols
- A 4-phase postoperative rehabilitation protocol utilizing milestone-based goals has been shown to be effective in returning athletes to pre-injury levels of activity and sport within 1 year following UCLR 5.
- Detailed preoperative planning, meticulous surgical technique, and a comprehensive rehabilitation program are essential components to achieving a satisfactory result 2.