UCL Reconstruction (Tommy John Surgery)

What is UCL Reconstruction?

Commonly called Tommy John surgery, this procedure involves reconstructing a damaged ligament on the inside of the elbow called the ulnar or medial collateral ligament with a tendon graft obtained from your own body or a donor.

UCL Anatomy

The ulnar collateral ligament (UCL), also called medial collateral ligament, is located on the inside of the elbow and connects the ulna bone to the humerus bone. It is one of the main stabilizing ligaments in the elbow, especially with overhead activities such as throwing and pitching.

UCL Injury

When this ligament is injured, it can end a professional athlete’s career unless surgery is performed. The common symptoms associated with a UCL injury are as follows:

Pain on the inner side of the elbow
Unstable elbow joint
Numbness in the little finger or ring finger
Decreased performance in activities such as throwing baseballs or other objects

UCL reconstruction surgery involves replacing a torn ulnar collateral ligament with a tendon from elsewhere in the body. It is also referred to as Tommy John Surgery.

Treatment of UCL Injuries

Your physician will recommend conservative treatment options to treat the symptoms associated with UCL injury unless you are a professional or collegiate athlete. In these cases, if the patient wants to continue in their sport, surgical reconstruction is performed.

Conservative treatment options that are commonly recommended for non-athletes include the following:

Activity restrictions
Orthotics
Ice compression
Medications
Physical therapy
Pulsed ultrasound to increase blood flow to the injured ligament and promote healing
Professional instruction

UCL Reconstruction

If conservative treatment options fail to resolve the condition and symptoms persist for 6-12 months, your surgeon may recommend ulnar collateral ligament reconstruction surgery. UCL reconstruction surgery repairs the UCL by reconstructing it with a tendon from the patient’s own body (autograft) or from a cadaver (allograft). The most frequently used tissue is the palmaris longus tendon in the forearm. The basic steps for UCL reconstruction surgery include the following:

The surgery is performed in an operating room under regional or general anesthesia
Your surgeon will make an incision over the medial epicondyle area
Care is taken to move muscles, tendons, and nerves out of the way
The donor's tendon is harvested from either the forearm or below the knee
Your surgeon drills holes into the ulna and humerus bones
The donor's tendon is then inserted through the drilled holes in a figure 8 pattern
The tendon is attached to the bone surfaces with special sutures
The incision is closed and covered with sterile dressings
Finally, a splint is applied with the elbow flexed at 90 degrees.

Postoperative care for UCL Reconstruction

After surgery, your surgeon will give you guidelines to follow, depending on the type of repair performed and the surgeon’s preference. Common postoperative guidelines include:

Elevate your arm above heart level to reduce swelling
Wear an immobilizing splint or cast for 1-3 weeks
Apply ice packs to the surgical area to reduce swelling
Keep the surgical incision clean and dry. Cover the area with plastic wrap when bathing or showering
Physical therapy will be ordered for strengthening and stretching exercises after the removal of the splint or cast
Professional athletes can expect a strenuous strengthening and range of motion rehabilitation program for 6-12 months before returning to their sport
Eating a healthy diet and not smoking will promote healing

Risks and Complications of UCL Reconstruction

As with any major surgery, there are potential risks involved.

The majority of patients suffer from no complications following UCL Reconstruction surgery, however, complications can occur following elbow surgery and include:

Infection
Limited range of motion
Nerve damage causing numbness, tingling, burning or loss of feeling in the hand and forearm area
Cubital Tunnel Syndrome
Elbow instability