Ulnar collateral ligament (UCL) reconstruction, or UCLR, is colloquially known as Tommy John surgery. It’s named after the first person, a pitcher for the Los Angeles Dodgers, to ever have the surgery. The Tommy John procedure is used to repair a UCL tear on the inner side of the elbow by replacing it with healthy tendon harvested elsewhere in your body or from donor tendon. This reconstructed tendon stabilizes the elbow joint again. The purpose of Tommy John surgery is to relieve pain and restore range of motion in the elbow so you can return to your normal activities. The ulnar collateral ligament is a thick band of tissue that creates a triangle shape on the inside of the elbow and supports the joint. Because overuse is the most common cause of a UCL tear injury, it’s most often seen among athletes who play throwing sports, such as baseball pitchers. A torn UCL destabilizes the elbow and gradually gets worse over time, weakening your arm. Usually, a doctor will recommend nonsurgical treatment options before considering Tommy John injury surgery. If rest, pain medicine, and physical therapy don’t relieve your symptoms, you might be a candidate for surgery. Competitive throwing athletes who suffer an acute UCL tear may need surgery to be able to return to their sport successfully. An orthopedic surgeon, often an elbow specialist, performs this elbow ligament surgery. When choosing your surgeon, it’s a good idea to find someone who is familiar with sports injuries, particularly elbow injuries. Get specific with the surgeon: ask about their experience with the surgery and relative costs. Tommy John surgery costs differ from practice to practice and vary depending on the surgical details, such as the source of the tendon graft. Tommy John surgery is usually an outpatient procedure that lasts for about an hour to an hour and a half. UCLR is open surgery and requires general anesthesia. During the procedure, the surgeon makes a 3- to 4-inch incision to access the joint and remove the damaged UCL. The surgeon will typically harvest a tendon graft from another part of your body—usually the forearm, hamstring or foot—to replace the torn UCL. This is an autograft. Sometimes, a donor’s tendon—an allograft from a tissue bank—is used for Tommy John surgery. The two most common methods for securing the tendon to the bones are the docking technique and the figure-eight technique. These refer to the way the tendon is looped through the holes drilled in the upper and lower arm bones. The surgeon drills holes in the arm bones to attach the graft tendon. What to expect the day of your Tommy John surgery In general, this is what happens the day of surgery: A nurse will help you prepare for anesthesia and surgery, which includes changing into a hospital gown, getting an intravenous (IV) line, and reviewing paperwork to sign before the procedure. The surgeon and anesthesia provider will explain the anesthesia and review the procedure with you. You will be moved to the operating room and the anesthesiologist or nurse anesthetist will start your anesthesia. The surgeon makes the incision, removes damaged tissue, and prepares the area for the graft tendon. You’ll have a surgical incision at the autograft donor site as well, unless you are receiving an allograft. After securing the graft and closing the incision, a surgical assistant will move you to a recovery room for monitoring. You can usually go home the same day if your vital signs are stable and there are no complications. Because this is a surgical procedure, anyone who has Tommy John surgery has the potential of developing minor or sometimes serious complications. General risks of surgery The risks that come with any type of surgery include: Complications from anesthesia, such as breathing problems Bleeding Blood clots such as a deep vein thrombosis Infection Damage to nearby nerves or blood vessels Potential complications of Tommy John surgery Complications of surgery to replace a torn UCL include: Stretching or rupture of the new tendon requiring another UCL reconstruction surgery Temporary or permanent neuropathy including numbness or weakness Additional surgery to treat ulnar neuropathy Inability to fully extend the elbow Chronic pain when throwing Reducing your risk of complications You can reduce your risk of complications from Tommy John surgery by: Following your physical therapy exercises as prescribed Calling your doctor immediately if you notice bleeding, fever, or increase in pain Telling your surgeon and anesthesia provider if you have had a bad reaction to anesthesia in the past You can prepare for Tommy John surgery by: Following all presurgery directions your surgeon provides Possibly stop taking certain medicines that increase the chance of developing a blood clot, if your doctor recommends Possibly stop taking medicines that could weaken your immune system, if your doctor recommends Learn about therapeutic exercises you will need to do during recovery. Preparing for what you will need to do afterwards may help your outlook going into surgery. Prepare your home to make recovery easier. You will have some limitations while you recover from surgery, so have precooked or easy-to-prepare meals on hand and comfortable clothes you can pull on and off without buttons or zippers. Questions to ask your doctor Ask your doctor any questions you may have ahead of time so you will be prepared the day of your surgery and during recovery. What time do I need to stop eating and drinking before the surgery? Do I need to stop taking any of my medications before surgery? How long will it be before I can return to sports and other activities? What exercises can I do to speed my recovery? Rehabilitation after UCLR surgery usually occurs in three phases. Immediately after surgery, your elbow will be immobilized in a brace to protect the joint, reduce swelling and promote healing of the new tissue. You will still be able to move your wrist and hand. After about 10 days, you can start moving your elbow while wearing a hinged brace. You will start physical therapy on the elbow at this time, focusing on range-of-motion exercises. In about a month, you’ll likely be able to take off the brace. How long will it take to recover? Most people can begin physical therapy immediately after surgery, working on the wrist, fingers and biceps so the muscles won’t atrophy while the elbow is immobilized. About 10 days later, you can begin physical therapy on the elbow joint, and within about a month, you’ll likely be able to fully extend your elbow. Depending on your typical activities, you may be fully healed within two to four months. For baseball pitchers or other throwing athletes, complete rehabilitation could take as long as a year. Will I feel pain? You may have pain after surgery. Keeping your elbow elevated can reduce pain, and you may be able to take over-the-counter pain relievers, such as nonsteroidal anti-inflammatory drugs. You may also feel pain as you progress through physical therapy exercises. Tell your physical therapist if the pain is preventing you from completing the exercises. It might be necessary to reduce the difficulty of the exercises until the pain and swelling subsides. When should I call my doctor? If you notice any symptoms of infection, such as fever or redness and warmth at the incision site, call your doctor right away. You should also tell your doctor if you have pain that you can’t manage with painkillers and reduced activity. How might Tommy John surgery affect my everyday life? With a successful Tommy John surgery, you should be able to return to your normal activities after a few months of physical therapy. Throwing athletes can even successfully return to competitive sports within nine months to a year after the surgery. Without any complications, you should be pain-free and have full range of motion in your elbow joint.