Tommy John surgery
- Also called:
- ulnar collateral ligament (UCL) reconstruction
- Related Topics:
- surgery
Tommy John surgery, surgery performed to repair the ulnar collateral ligament (UCL) on the medial side of the elbow by using a graft as a substitute. The surgery is most commonly performed on athletes in throwing sports, especially baseball pitchers. The goals of Tommy John surgery are increasing elbow comfort, stability, and range of motion as well as prolonging the careers of athletes with a damaged or destroyed UCL.
Origins
This surgery was first performed in September 1974, by orthopedic surgeon Frank Jobe on pitcher Tommy John, who was playing for the Los Angeles Dodgers. At that time, elbow soreness and subsequent surgery often meant the end of a baseball pitcher’s career. When Jobe examined John’s throwing arm, he noticed that the UCL was simply absent. Because the UCL connects the humerus in the upper arm to the ulna in the forearm, it is under stress in a pitcher’s arm. The UCL is therefore susceptible to being pulled, stretched, and eventually torn, and the risk of damage increases with the number of pitches thrown.
Thousands of Major League Baseball players, most of them pitchers, have had Tommy John surgery. Just a few of these players are:
- Shohei Ohtani, who had the surgery twice, in 2018 and 2023
- Justin Verlander, who had the surgery and then won his third Cy Young Award, in 2022, at age 39
- John Smoltz, the first player who had the surgery to enter the Baseball Hall of Fame
- Bryce Harper, a position player who returned from the surgery in just five months
In the case of John, who had been pitching in the major leagues since 1963, the UCL in his left arm, with which he threw, had been destroyed. In order to restore John’s UCL, Jobe took a tendon from John’s right wrist and used it as a UCL substitute. After successful surgery and rehabilitation, John returned to pitching in 1976.
In 1977 he finished second to Steve Carlton of the Philadelphia Phillies in the voting for the National League Cy Young Award, and he continued pitching until 1989. Thousands of baseball players have since received Tommy John surgery in order to prolong their careers.
Procedure
Tommy John surgery is performed when the UCL is partially or fully torn or severely deteriorated. The surgery can take anywhere from 45 to 90 minutes to complete, depending on the condition of the elbow and the surgeon’s discretion. It is often an outpatient procedure that is performed under general anesthesia.
The first step is to harvest the graft, which is the tendon that will be used as a UCL substitute. The graft typically originates from one of three tissues: the palmaris longus tendon in the forearm, a hamstring tendon at the back of the knee, or the extensor tendon to the big toe. While this graft is often taken from the patient’s own body, it can also be harvested from a living donor or a cadaver.
Surgery begins with an incision centered over the UCL, on the inside of the elbow. Muscles and tendons are moved aside in order for the surgeon to inspect the damaged UCL. Holes are then drilled in the humerus and ulna where the UCL normally connects the two bones. A variety of techniques can then be used to connect these bones with the tendon graft, including the so-called figure-eight method, by which the tendon is threaded through the holes and the free ends are sutured to each other.
Recovery time
Because of the seriousness of the surgery, especially for baseball players, recovery times are long. After the procedure, athletes generally require treatment and physical therapy for at least six months before they begin using their arm again. Additional rehabilitation is typically necessary before any athlete is ready to return to competition, and pitchers often need more than a year of rehabilitation before they can play at a level similar to the one before the UCL injury.