TOMMY JOHN SURGERY
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What is the Ulnar Collateral Ligament?
The Ulnar Collateral Ligament runs through the inside the elbow joint and stabilizes the connection between the bones of the arm. Subjecting the elbow joint to a strong enough force can tear the ligament, which results in pain and instability.
Even if patients can avoid a catastrophic elbow injury, the UCL can still degrade from repetitive wear and tear, such as years of playing sports and throwing objects.
Physicians define a sprain as a stretching or tearing of the ligaments: bands of thick, fibrous tissue that connect the bones together through the joints. Ankles tend to have the highest risk of suffering a sprain.
Immediate treatment for a sprain should include the RICE strategy: rest, ice, compression and elevation. Mild sprains will usually heal at home on their own when following this method, though severe sprains will sometimes require surgery in order to repair torn ligaments.
The main difference between sprains and strains: A sprain injures the tissue that connects the bones together, while a strain injures a muscle or to the tissue that attaches muscle to bone.
How Serious is a UCL Injury?
Unlike some other injuries, the UCL has a hard time healing on its own, and will usually lose some degree of strength even if it does. Upper Extremity Specialists classify UCL tears into different grades depending on the extent of the tear.
- First-Degree Sprains: While still painful, this level of injury does not seriously damage the ligament.
- Second-Degree Sprains: The ligament will stretch, but not completely tear. Second degree sprains will still allow patients to make use of the arm.
- Third-Degree Sprains: A complete tear of the ligament that does not allow patients to continue using the arm.
In pro-sports, athletes used to consider their career over if they suffered a UCL tear, but with the development of Tommy John Surgery, modern orthopedic upper extremity specialists can repair UCLs and return athletes to a competitive level.
What is Tommy John Surgery?
Through traumatic injuries or simple overuse, the ulnar collateral ligament can fully or partially tear away from the bone, leading to issues using the arm in certain positions. Upper Extremity Specialists often use UCL reconstruction to repair a torn ulnar collateral ligament inside the elbow. They do this by replacing it with another tendon from elsewhere inside the patient’s body. UCL Reconstructions work to stabilize the elbow, reduce pain and restore the stability and motion of the joint. Dr. Frank Jobe first introduced and performed this surgery on the professional Baseball Pitcher Tommy John in 1974, leading to the more common name for the reconstruction, “Tommy John surgery”.
How Do Orthopedic Upper Extremity Specialists Perform Tommy John Surgery?
Orthopedic Upper Extremity Specialists can typically perform Tommy John Surgery as an outpatient procedure, meaning patients can most likely return home on the same day. Specialists can perform UCL reconstruction in 60 to 90 minutes.
In a UCL reconstruction, physicians graft a new tendon onto the UCL to repair the damage. Physicians can harvest this replacement tendon from various other areas of the body or from a tendon donor. These donor tendons can include:
- The Palmaris longus tendon the arm
- The Hamstring
- The Extensor tendon from the Big Toe
Doctors then make a 3 – 4 inch incision on the elbow joint to access the inside of the elbow. The surgeon removes the damaged tendon tissue and attaches the new tendon graft.
In order to attach the new tendon graft while maintaining elbow functionality, the surgeon will drill holes into the upper arm bone (humerus) and the lower arm bone (ulna). Then, the surgeon threads the new tendon through the holes and ties them down with sutures or screws.