UCL Reconstruction (Tommy John Surgery)
UCL Reconstruction (Tommy John Surgery) in West Palm Beach, Jupiter & Palm Beach Gardens, FL
A torn or damaged ulnar collateral ligament (UCL) can cause pain on the inner side of the elbow, instability, and difficulty with throwing or other overhead activities. UCL reconstruction, commonly known as Tommy John surgery, may be recommended for selected patients with significant ligament damage who have not improved with appropriate nonsurgical treatment. Dr. Brian W. Hill, MD, FAAOS, is a board-certified orthopaedic surgeon and fellowship-trained shoulder and elbow specialist providing advanced elbow care in West Palm Beach, Jupiter, and Palm Beach Gardens, FL. He evaluates each UCL injury individually to determine the most appropriate treatment approach.
What is UCL Reconstruction?
Commonly called Tommy John surgery, this procedure involves reconstructing a damaged ligament on the inside of the elbow called the ulnar or medial collateral ligament with a tendon graft obtained from your own body or a donor.
What is UCL Anatomy?
The ulnar collateral ligament (UCL), also called medial collateral ligament, is located on the inside of the elbow and connects the ulna bone to the humerus bone. It is one of the main stabilizing ligaments in the elbow, especially with overhead activities such as throwing and pitching.
What is UCL Injury?
When this ligament is injured, it can end a professional athlete’s career unless surgery is performed. The common symptoms associated with a UCL injury are as follows:
- Pain on the inner side of the elbow
- Unstable elbow joint
- Numbness in the little finger or ring finger
- Decreased performance in activities such as throwing baseballs or other objects
UCL reconstruction surgery involves replacing a torn ulnar collateral ligament with a tendon from elsewhere in the body. It is also referred to as Tommy John Surgery.
What is the Treatment for UCL Injuries?
Your physician will recommend conservative treatment options to treat the symptoms associated with UCL injury unless you are a professional or collegiate athlete. In these cases, if the patient wants to continue in their sport, surgical reconstruction is performed.
Conservative treatment options that are commonly recommended for non-athletes include the following:
- Activity restrictions
- Orthotics
- Ice compression
- Medications
- Physical therapy
- Pulsed ultrasound to increase blood flow to the injured ligament and promote healing
- Professional instruction
UCL Reconstruction
If conservative treatment options fail to resolve the condition and symptoms persist for 6-12 months, your surgeon may recommend ulnar collateral ligament reconstruction surgery. UCL reconstruction surgery repairs the UCL by reconstructing it with a tendon from the patient’s own body (autograft) or from a cadaver (allograft). The most frequently used tissue is the palmaris longus tendon in the forearm. The basic steps for UCL reconstruction surgery include the following:
- The surgery is performed in an operating room under regional or general anesthesia
- Your surgeon will make an incision over the medial epicondyle area
- Care is taken to move muscles, tendons, and nerves out of the way
- The donor's tendon is harvested from either the forearm or below the knee
- Your surgeon drills holes into the ulna and humerus bones
- The donor's tendon is then inserted through the drilled holes in a figure 8 pattern
- The tendon is attached to the bone surfaces with special sutures
- The incision is closed and covered with sterile dressings
- Finally, a splint is applied with the elbow flexed at 90 degrees.
What Does Postoperative Care for UCL Reconstruction Involve?
After surgery, your surgeon will give you guidelines to follow, depending on the type of repair performed and the surgeon’s preference. Common postoperative guidelines include:
- Elevate your arm above heart level to reduce swelling
- Wear an immobilizing splint or cast for 1-3 weeks
- Apply ice packs to the surgical area to reduce swelling
- Keep the surgical incision clean and dry. Cover the area with plastic wrap when bathing or showering
- Physical therapy will be ordered for strengthening and stretching exercises after the removal of the splint or cast
- Professional athletes can expect a strenuous strengthening and range of motion rehabilitation program for 6-12 months before returning to their sport
- Eating a healthy diet and not smoking will promote healing
What are the Risks and Complications of UCL Reconstruction?
As with any major surgery, there are potential risks involved.
The majority of patients suffer from no complications following UCL Reconstruction surgery, however, complications can occur following elbow surgery and include:
- Infection
- Limited range of motion
- Nerve damage causing numbness, tingling, burning or loss of feeling in the hand and forearm area
- Cubital Tunnel Syndrome
- Elbow instability
Why Choose Dr. Hill for UCL Reconstruction (Tommy John Surgery)?
Fellowship-Trained Orthopaedic Surgeon
Dr. Hill completed his orthopaedic surgery residency at St. Louis University followed by a shoulder and elbow surgery fellowship at Rothman Orthopaedic Institute and Thomas Jefferson University Hospitals in Philadelphia. His advanced training includes reconstructive and arthroscopic procedures of the shoulder and elbow.
Comprehensive UCL Evaluation
Not every UCL injury requires surgery. Dr. Hill evaluates the location and severity of the ligament injury, symptoms, elbow stability, imaging findings, athletic or occupational demands, and response to previous treatment when determining the appropriate course of care.
Individualized Surgical Planning
When UCL reconstruction is recommended, surgical planning takes into account the patient's anatomy, ligament injury, activity requirements, and graft options. The goal is to create a reconstruction that provides appropriate elbow stability while supporting a structured rehabilitation program.
Advanced Reconstructive Care
UCL reconstruction uses a tendon graft to recreate the function of a damaged ligament. Depending on the patient's circumstances and surgical technique, the graft may come from the patient's own body or another appropriate source.
Rehabilitation-Focused Treatment
Successful recovery from Tommy John surgery requires a gradual rehabilitation process. Dr. Hill provides postoperative guidance designed to protect the reconstruction while progressively restoring elbow motion, strength, and function.
UCL Reconstruction (Tommy John Surgery) FAQs
What is UCL reconstruction? +
UCL reconstruction is a surgical procedure that uses a tendon graft to reconstruct a damaged ulnar collateral ligament on the inner side of the elbow. It is commonly called Tommy John surgery and is most often associated with athletes who participate in repetitive throwing activities.
Who may need Tommy John surgery? +
UCL reconstruction may be considered for patients with significant UCL damage and persistent elbow instability or symptoms that do not respond adequately to appropriate nonsurgical treatment. The decision depends on the injury, symptoms, activity level, and functional goals.
Does every UCL tear require surgery? +
No. Some UCL injuries can be managed with activity modification, physical therapy, and other nonsurgical treatments. Surgery is generally considered when the injury and symptoms warrant reconstruction, particularly when persistent instability or inability to return to desired activities remains despite conservative care.
What happens during UCL reconstruction? +
During Tommy John surgery, the damaged UCL is reconstructed using a tendon graft. The surgeon creates fixation sites in the humerus and ulna and secures the graft to recreate the stabilizing function of the original ligament. The specific surgical technique varies according to the injury and patient.
Where does the tendon graft come from? +
A graft may be taken from another tendon in the patient's body, commonly the palmaris longus tendon when suitable, or an alternative graft may be considered. The appropriate graft depends on the patient's anatomy and the surgeon's preferred technique.
How long does recovery take after Tommy John surgery? +
Recovery varies considerably based on the patient's age, injury, surgical technique, rehabilitation progress, and activity goals. Throwing athletes generally require a lengthy, progressive rehabilitation program before returning to competitive throwing. Your surgeon and rehabilitation team will determine when it is safe to advance activities.
Can I return to sports after UCL reconstruction? +
Many athletes are able to return to sports following appropriate treatment and rehabilitation, but return to play is not guaranteed. Throwing athletes typically progress through a structured rehabilitation and throwing program before being cleared for competitive activity.
What are the risks of UCL reconstruction? +
Potential complications include infection, bleeding, stiffness or loss of motion, persistent instability, graft problems, and nerve irritation or injury. Because the UCL is located near important nerves, nerve-related symptoms can occur. Your surgeon will discuss the potential risks and benefits before surgery.
Schedule a UCL Reconstruction Consultation in West Palm Beach, Jupiter or Palm Beach Gardens, FL
If persistent inner elbow pain, instability, or difficulty with throwing is affecting your athletic performance, work, or daily activities, a specialized evaluation can help determine the cause and appropriate treatment. Dr. Brian W. Hill, MD, provides advanced shoulder and elbow care for patients throughout West Palm Beach, Jupiter, Palm Beach Gardens, Wellington, and surrounding Palm Beach County communities. Contact the office to schedule a consultation and learn whether nonsurgical treatment, UCL reconstruction, or another approach may be appropriate for your elbow injury.
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