Tommy John surgery is a surgical procedure which is used to repair the ulnar collateral ligament (UCL). The ulnar collateral ligament is located on the inside of the elbow joint which is why the procedure is most commonly associated to athletes, particularly baseball pitchers. The procedure is known as Tommy John surgery because he was the first professional pitcher to undergo the procedure in 1974 while a member of the LA Dodgers that came back to successfully resume his career.
Over the years since Tommy John had his surgery performed by Dr. Frank Jobe whom developed it, the procedure has advanced significantly to the point that some feel pitchers who have had the operation come back better than before. After surgery, John went on to pitch another 14 years until he was 46. He often joked that he may be in his 40’s, but his arm was just a kid. Aside from Tommy John, there have been many big name athletes that had the surgery like Eric Gagne, Rick Ankiel, Erik Bedard, Mariano Rivera, Tim Hudson, John Smoltz, and now Stephen Strasburg can be added to the list as well.
The reason the UCL is often damaged is because it is susceptible to heavier than normal wear and tear through repetitive stressful motion. The UCL can be stretched, frayed, or under the worst of circumstances torn. The UCL along with the lateral collateral ligament connect the ulna and humerus which is what provides the elbow with stability. If it fails to heal correctly, then the elbow will remain unstable, and left to heal on it’s own naturally, it never seems to repair itself to be capable of providing the stability it once did which is why surgery is often performed.
The procedure itself is performed by first harvesting a ligament to replace the UCL. The next step is removing things like bone spurs in the elbow, although this step is not necessary in all cases. Going through the medial side of the elbow joint, which is the side near the body, the UCL which is damaged is removed and replaced with the harvested tendon.
The major changes in the procedure performed today as opposed to when Dr. Jobe began is that the ulnar nerve is only re-routed if the patient was displaying symptoms of ulnar nerve damage prior to the procedure, and that the flexor muscles are split and retracted rather than detached to provide access. Despite the advances, there is still always the risk of infection or nerve damage, and the replacement itself does not guarantee that the elbow will be more stable than prior to the surgery. About one half of those undergoing the surgery experience a 5 to 10 degree loss of elbow extension which means they cannot fully straighten their arm. The recovery time is usually pegged at 12-18 months depending on the progress made rehabilitating the elbow after surgery.