Tommy John surgery (UCL reconstruction)

Tommy John surgery, also known as ulnar collateral ligament (UCL) reconstruction, is a procedure to repair or replace a damaged UCL. The UCL is a strong band of tissue that helps stabilize the elbow joint. It connects the upper arm bone (humerus) to the ulna (one of the forearm bones) and keeps the elbow from bending too far the wrong way during forceful movements like throwing. A torn UCL causes pain and limits mobility in your elbow.

Named for the professional baseball pitcher who was first to undergo the procedure in 1974, Tommy John surgery is performed to reduce pain and improve range of motion. At Penn Medicine, our orthopaedic elbow surgeons have deep experience in tendon and ligament reconstruction, including Tommy John surgery. Additionally, we support your recovery through pain management and physical therapy to help you return to your regular activities as soon as possible.

In traditional Tommy John surgery, the surgeon replaces your damaged ulnar collateral ligament with a tendon from another part of your body or, in some cases, from a donor. The replacement tendon is called a graft. The surgeon attaches the graft to your upper arm and forearm bones to restabilize your elbow.

Athletes in sports that involve repeated, strenuous overhead or throwing activities are most likely to get an overuse injury to the UCL that may require Tommy John surgery. Less commonly, people who experience traumatic injuries to the UCL may be candidates. For example, falling onto your outstretched arm could tear your UCL.

If nonsurgical treatments like medication, rest, and physical therapy don’t bring improvement, it may be time to consider surgery to repair your UCL. Your Penn Medicine care team can advise you on the best treatment plan.

You should not experience pain during Tommy John surgery as you will be unconscious under general anesthesia. You may also be given regional anesthesia (a nerve block) for pain management that continues beyond surgery.

During the procedure, your surgeon will:

• Take a healthy tendon from your forearm or hamstring to use as a graft to reconstruct the UCL (though in some cases a donor tendon is used).
• Make a three- to four-inch incision on the inside of your elbow to access the UCL and remove the damaged tissue.
• Drill holes in the upper arm and forearm bones, thread the grafted tendon through the holes, and stitch it into place. Or, if using an internal brace, attach the grafted tendon with small anchors, such as screws.
• Close the incision with stitches.

The surgery typically takes 60 to 90 minutes.

Recovery time after UCL repair surgery depends on how fast your tissues heal. After surgery, rest is very important to healing. When your doctor thinks you’re ready, you’ll begin physical therapy to regain strength, range of motion, and function.

Immediately after surgery and likely through the first couple of weeks, your arm will be immobilized in a hard splint to protect the surgical site. You can expect some mild soreness and swelling at the graft site for a few days. Other recovery milestones include:

• In two to six weeks, you may transition to using a hinged brace that allows limited movement, and you’ll gradually begin therapeutic exercises.
• In six to eight weeks, you may be able to resume driving.
• In six weeks to three months, your physical therapy may focus on regaining full range of motion and building strength in the elbow and forearm.
• In three to six months, if you’re an athlete, you may begin sports-specific training.
• In 12 months, you may be able to return to competitive sports or other high-intensity activities, though full recovery could take longer.

Like any surgery, Tommy John surgery carries certain risks. While it’s generally safe and effective, you should be aware of potential complications, including:

• Blood clots
• Infection
• Damage to the ulnar nerve
• Persistent elbow stiffness
• Numbness around the incision
• Re-tearing of the repaired ligament
• Failure to return to previous level of performance

Penn Medicine’s orthopaedic surgeons are experts in ligament and tendon reconstruction to help restore function, strengthen the elbow, and alleviate pain from UCL tears. Our team—including surgeons, pain specialists, and physical therapists—will collaborate on a comprehensive treatment plan that’s right for you. We perform UCL reconstruction using the latest advanced techniques and work to control your pain without overreliance on narcotics.

With Penn Medicine, you can rely on:

• Highly skilled surgeons recognized for excellence in orthopaedic care
• Convenient access to the latest technology and treatments
• Continuous support with seamless communication among care providers

Whether you seek to return to athletic competition or simply want to resume daily activities without discomfort, we’re dedicated to addressing your unique needs and recovery goals. Our care extends long after surgery. We keep working with you until you’re fully healed and feeling strong.