UCL Tear

Tommy John Surgery is performed to reconstruct a ruptured (torn) UCL on the inside of the elbow. A torn UCL cannot function or heal itself. The goal of Tommy John Surgery is to stabilize the elbow, reduce pain and restore range of motion. The average age of a patient who receives Tommy John Surgery is 27, but the incidence of UCL reconstruction is increasing in the young amateur athlete in the 15-19 age group.

Tommy John Surgery is the most famous medical procedure in all of sports. The procedure was first performed by Dr. Frank Job in 1974. It is named after Tommy John a Major League Baseball All-Star pitcher who went on to win 164 games after having this revolutionary surgery to replace his torn UCL. Before Tommy John Surgery, a torn UCL was a career-ending injury. The success rate is between 80 and 90%. 80 – 95% of people who undergo Tommy John Surgery will return to play. However, return to sport can take 12 – 18 months after surgery. Rehabilitation after UCL reconstruction is essential for proper healing of the reconstructed ligament and for the safe return to competition.

The ulnar collateral ligament is the primary elbow stabilizer. Trauma and chronic overuse can cause a UCL injury and elbow instability. A tear in the UCL is a common sports injury in athletes who participate in throwing sports like baseball.  It is an overuse injury that is also found in people whose job requires a lot of bending of the elbow.

As with other overuse injuries, when the UCL is subjected to repeated stress it creates microscopic tears in the ligament that with repeated use eventually results in a partial ligament tear and a complete tear of the ligament off the bone. The UCL can also be torn when falling on an outstretched arm.

Symptoms include a slow onset of elbow fatigue, loss of control and stamina, soreness and tingling in the fingers. An acute rupture of the ligament can make a popping sound, cause intense pain on the inside of the elbow, loss of grip strength and elbow instability. In young patients here may be tenderness in the joint that could suggest a stress fracture.

Diagnosis is made by a combination of history, physical exam, symptoms, and MRI, X-ray and ultrasound imaging. Dr. Petrigliano will perform specific examination maneuvers to test strength and stability.

Nonsurgical treatment may be considered for non-throwing and low-demand athletes and when the UCL injury is in the non-dominant arm or a partial rupture. Multiple factors must be considered such as demand of a sport, grade and location of the tear, level of play and the individual athlete’s needs. If nonsurgical treatment is recommended Dr. Petrigliano may recommend biologic augmentation with platelet-rich plasma (PRP) injections to facilitate healing. 

Tommy John Surgery is an outpatient procedure usually performed under regional anesthesia with sedation. It that can be accomplished as an arthroscopic procedure or open surgery. During surgery, the torn UCL is repaired and augmented with a tendon. The tendon graft is obtained from the patient or a donor. To attach the tendon graft to bone, Dr. Petrigliano will drill holes in the upper arm bone and the lower arm bone, insert the tendon and secure it with sutures and screws. If there is some healthy original ligament tissue, it may be attached to the new tendon graft for added strength. Dr. Petrigliano may also augment the reconstruction with platelet-rich plasma (PRP) to enhance healing.

In addition to the typical risks of all surgeries such as bleeding, infection, and pain. There may be pain at the site where the graft was harvested, nerve irritation and stiffness and swelling.

Tommy John Surgery is the gold standard treatment for professional and elite throwers with full-thickness partial UCL tears and those who sustain a complete avulsion tear, where the tendon is torn off the bone.