Tommy John Surgery

Tommy John surgery is a commonly used name for ulnar collateral ligament (UCL) reconstruction. There are several different methods to reconstruct torn UCL, such as Jobe procedure, docking technique, modified docking technique, DANE procedure, etc. There are different fixation methods, different graft donating sites, different approach to the ligament, etc. Originally, the procedure was done detaching the forearm muscle group to access the reconstruction site. However, it is more common now to split the muscle instead of detaching it. Usually, the muscle in the forearm called palmaris longus is used as a graft, however, it can be taken from the knee muscle. Also, originally, ulnar nerve transposition (relocating the 'funny bone' nerve) was done at the same time the Tommy John surgery was done. However, it may not be done unless the athlete is having ulnar nerve symptoms. There are several variations to this procedure, but, the goal of the surgery is to regain stability to the elbow by reconstructing a torn UCL which provides static constraint to the medial side of the elbow in throwing motion. 

       Rehabilitation after UCLR is a long process. It usually takes about 10-12 months to return to full pitching activities. Even after returning to full pitching, a pitch count and innings pitched may be limited. Studies show about 85% success rate after the procedure. However, it may take longer than 12 months to return to pre-injury performance level. Recently, Stephen Strasburg of Washington Nationals came back from Tommy John surgery and seems to be pitching well. Joe Nathan (Texas Rangers) is in his 2nd year coming back, I believe. Fransisco Lariano (Minnesota Twins) seems to be struggling. Adan Wainright (St.Louis Cardinals) is pitching his first season after the surgery.

       We will discuss rehabilitation after UCLR later.