What is Tommy John Surgery?

Tommy John surgery is a procedure to repair an injured elbow ligament. It is also known as UCL reconstruction surgery, which refers to the damaged ulnar collateral ligament. A surgeon performs the operation by taking a tendon from another part of the body to replace the injured UCL. The surgery became popular in the late 1970s and surgeons still practice it today. It is a common surgery for athletes, especially baseball players, because repetitive throwing motions often cause the injury.

The Name

The Tommy John surgery got its name from the first person to ever have it. Tommy John was a winning pitcher for the Los Angeles Dodgers in 1974 when he suffered a career-ending injury to his UCL. He opted to have the groundbreaking surgery orthopedist Dr. Jobe had invented but never performed on an athlete. Tommy John spent the 1975 season in recovery and came back in 1976 with what was considered a miraculous return. His record was 10-10, and he continued to win 164 games post-surgery.

Necessity of Surgery

The ulnar collateral ligament is responsible for maintaining a healthy working relationship between the humerus and the forearm. The ligament is the arm’s source of stability, and when the injury occurs, this impacts arm functionality. Constant throwing motions such as pitching a baseball can cause the ligament to strain or tear. It is possible to rest the ligament and live a healthy life without the surgery, however, not having it repaired makes it almost impossible to pitch a baseball at Major League speeds.

Who Receives the Surgery

Surgeons most often perform this procedure on professional athletes, predominately baseball players; Tommy John surgery is responsible for saving several careers. Tennis players are another group that significantly benefit from this procedure. Anyone with a torn UCL can benefit from the surgery, as it makes general movements more comfortable. However, conventional methods like physical therapy and rest are the first option before turning to surgery.

Signs of a UCL Tear

An injury to the ulnar collateral ligament can develop slowly over time from constant throwing motions, or it can happen in a single traumatic event. A gradual injury will often cause aching pain in the elbow area that may get better with rest. In a severe tear, some people notice a popping sound followed by extreme pain when the ligament tears. They may also have numbness in the hand and fingers.

Recovering from Tommy John Surgery

The recovery time after having Tommy John surgery depends on what the person will be doing. A professional baseball pitcher will probably need a year of rehabilitation before therapists recommend returning to pitching. Players in other positions, tennis players, and non-athletes will likely need three to six months of recovery. The doctor will place a splint immediately following the surgery to promote immobility. When ready, patients attend therapy regimens that increase their abilities and strength until they recover.

Does Surgery Improve Performance?

Some people believe Tommy John surgery enhances a pitcher’s future performance. This could be due to the successful returns that some baseball greats have had following the surgery. The fact is the operation doesn’t improve performance or pitching speeds. These factors can be adjusted, but are likely due to the rehabilitation process and strengthening of the arm overall. Orthopedic surgeons report requests by families to perform the surgery on young athletes who do not have an injury in hopes of enhancing performance.

The Tendon that Replaces the UCL

In the early days, the tendon used to replace the UCL came from human cadavers. Today, surgeons removing a non-essential tendon that attaches to the palmaris longus muscle in the forearm, and serves no function. Interestingly, 15% of the population is missing this tendon. In this case, the doctor will take a ligament from the ankle or hamstring.

Dr. Jobe

Dr. Frank Jobe is the man responsible for discovering and performing the very first Tommy John surgery. The orthopedic surgeon had performed the surgery on polio patients, but never an athlete. After the success of the surgery on Tommy John, Dr. Jobe went on to complete more successful procedures. He also performed a radical shoulder surgery that saved the career of Orel Hershiser, another MLB pitcher, in 1990.

UCL Revision

A modest number of patients who undergo Tommy John surgery end up requiring UCL revision surgery. The number has increased in the past five years among pitchers in the MLB. New injuries or tears can occur from the high demands of the game. Reports show the success of the second surgery is lacking compared to the initial reconstruction and rehabilitation time is longer.

New Advances

Dr. Jeff Dugas is a top orthopedic surgeon who has performed thousands of UCL reconstruction surgeries. He recognized that many of the ligaments he replaced weren’t damaged and were, in fact, repairable. He began experimenting with high-grade medical tape to repair the damaged ligament. His first successful repair was done in 2013 and advances have taken off from there. Dugas developed a new procedure called ulnar collateral ligament repair. He also invented the Internal Brace Ligament Augmentation system to fix the damaged part of the ligament. This alternative surgery is less invasive and the recovery time is half that of a total replacement. Dugas has completed several successful repairs. The procedure has gained attention from professional sports, but requires more research before the major leagues begin widely considering it as an alternative to Tommy John surgery.