An Overview of Tommy John’s Surgery

tommy john's surgery

Athletes sustain injuries frequently, and some of these wounds can have life-long consequences. Many have to quit the field entirely because they suffered a career-ending injury. Fortunately, doctors and researchers work continuously to come up with effective treatments for such cases. Tommy John’s Surgery is a perfect example of this. Here’s a brief overview of this procedure:

When do You Need Tommy John’s Surgery?

Repetitive stress injuries are common in sports. Athletes that pitch or continuously throw fastballs often sustain Ulnar Collateral Ligament (UCL) damage. This damage occurs when the constant stress or exertion causes an ulnar ligament tear. You’ll hear or feel a popping sensation along with immediate numbness. Other symptoms include swelling in the inner part of an elbow, a weakened grip, elbow stiffness, inability to straighten the arm without significant discomfort, and a tingling sensation.

History of This Surgery

Tommy John’s Surgery is formally known as Ulnar Collateral Ligament Reconstruction. Its primary objective is to stabilize a patient’s elbow, eliminate pain, and restore range of motion. Most athletes return to the field in a year or so after undergoing this surgery.

This reconstruction was first introduced by Frank Jobe, M.D., a well-known orthopedist who treated Major League Baseball pitcher Tommy John back in 1974. Until 1974, a ligament tear was considered permanent. Athletes with this injury had a ‘dead arm’ with long-term mobility issues. Dr. Jobe came up with an effective way to restore the UCL that lets athletes resume their careers after recovery. Around 85% of the athletes were able to continue playing with no compromise in skill.

What Happens During Tommy John’s Surgery?

UCL reconstruction is an outpatient procedure performed by a board certified orthopedic surgeon that takes around 60 to 90 minutes. Patients can return home after the surgery is done and complete their recovery. You’ll be given general anesthesia, so make sure someone accompanies you for the procedure.

This procedure involves taking a tendon from some other part of your body or a donor and replacing a damaged UCL with it. Here’s a more detailed look at what happens:

  1. Harvesting a Graft

The surgeon will first harvest a graft from some other part of your body like a palmaris longus tendon, big toe extensor tendon, or hamstring tendon. A doctor can harvest a ligament from any part of a patient’s body, but these three locations are ideal.

  1. Cleaning a Joint

A surgeon will make a 3-4 inch incision outside the patient’s elbow to access the torn UCL. They will move all muscles and tissue aside and examine the damaged area carefully. The surgeon will then remove all the damaged tissue and only small sections of the original ligament if necessary. These fragments can help reinforce a new graft, making your elbow more stable.

  1. Adding the Graft

There are several ways of adding a graft to an elbow joint. Many surgeons use a docking or figure 8 technique, both of which have high success rates. Here’s a look at this process:

  • The surgeon drills holes in the upper arm (humerus) and lower arm (ulna) bones.
  • They thread the graft tendon through these holes carefully, making sure not to cause any damage.
  • The graft is secured in place with screws, buttons, or sutures.

Once the graft is in place, everything is stitched up once again. This procedure has a high success rate, but complications can happen. Some patients develop infections at the implant or harvest sites. The new graft can also tear or rupture, especially if it isn’t secured correctly. Patients can sustain blood vessel or nerve damage, which causes temporary or permanent numbness.

Patients should not move their elbow for around 1-2 weeks after the surgery. Once the site is healed, you can start on physical therapy for a complete recovery. For more information on elbow injuries, surgery, or other sports-related injuries, please contact Orthopaedic Specialists at 502-212-2663.