Medial ulnar collateral ligament reconstruction (Tommy John surgery)

Tommy John surgery is a procedure to repair a torn ulnar collateral ligament (UCL)—the ligament that holds the upper and lower arm bones together in the elbow. During Tommy John surgery, the surgeon takes a healthy tendon from elsewhere in the body (the forearm or sometimes the leg) to reconstruct the torn UCL. The healthy tendon is threaded through holes drilled into the bone above and below the elbow.

Surgery is designed to restore medial stability of the elbow and help athletes return to high-level, competitive activities. The technique is one of the major advancements in sports medicine in the last quarter century and typically yields excellent results.

Who is a candidate for this procedure?

Most people associate Tommy John surgery with baseball. And indeed, the vast majority of athletes who undergo the procedure are pitchers. It was named for Major League Baseball pitcher Tommy John, who was first to have the operation in 1974. But Tommy John surgery is not just for pitchers anymore. Today, it is increasingly common among a wide range of young athletes who have sustained UCL injuries, including wrestlers, javelin throwers and volleyball players.


The elbow is made up of the humerus (upper arm bone), the ulna (the large forearm bone) and the radius (the small forearm bone). Muscles, ligaments and tendons hold the elbow joint together. Two ligaments —the UCL and the lateral collateral ligament—connect the humerus to the ulna and help stabilize the elbow during overhand throwing.

When is surgery recommended?

Not all UCL injuries require surgery. Most are treated with conservative measures such as rest, ice and over-the-counter pain medications. Physical therapy to strengthen surrounding muscles is also effective. However, high-level athletes who sustain a severe injury or want to resume strenuous overhead or throwing activities benefit from having the procedure as soon as possible after their injury.

What is the recovery time?

Rehabilitation from UCL surgery is a difficult and challenging process. It takes time for the new ligament to stabilize. Patients typically spend the first 10 days in a splint to hold the elbow immobilized at 90 degrees. Rehabilitation begins with controlled range of motion for six weeks, then progressive strengthening for six months or more. Most athletes come back within a year. Pitchers start incremental throwing as part of their return. Once they rejoin the rotation, they are typically put on a pitch limit to protect the repair and prevent re-injury.

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