Tommy John Surgery

FAQs on Tommy John Surgery in Arizona

 

Tommy John surgery or ulnar collateral ligament reconstruction is touted as the career saver of many sportspersons, notably baseball pitchers. Named after former MLB pitcher and LA Dodgers great Tommy John, the surgery was first performed in 1974 by Dr Frank Jobe. The tendon transplant procedure enabled the player, whose career was almost ended with a torn elbow ligament, returned to the major league playing for 14 more seasons. His success made the surgery a viable treatment for elbow ligament tears extending careers of many of his costars and fellow sportspersons.

What is Tommy John surgery?

The medical name of Tommy John surgery is ulnar collateral ligament reconstruction. Ulnar collateral ligament, which is another name of medial collateral ligament, is torn or damaged due to repetitive stress caused by overuse. The surgical procedure replaces the ligament with a graft tendon taken from forearm, hamstring, knee, or foot.

Athletes suffer from ulnar collateral ligament tear when their training or sports participation leads to lot of stress on the elbow. Repetitive stress results in inflammation, trauma, and tears in the ligament. A torn ulnar collateral ligament prevents “throwing with significant force or speed,” which may threat careers of javelin throwers or baseball pitchers.

However, the ulnar collateral ligament reconstruction using a tendon graft enables 85 to 90 percent successful recovery and restores optimum strength of the elbow.

What are conditions treated with Tommy John surgery?

The ulnar collateral ligament, a thick band of fibrous tissue, positioned on the medial side of elbow, keeps the forearm connected with the upper arm. It is one of the two vital ligaments in the elbow joint and ensures smooth sliding of the forearm without getting displaced. Injury, stress, dislocation, or overuse causes tears in the ligament. Unless treated properly, it makes the elbow unstable.

Those participating in throwing sports, such as javelin throw, tennis, softball, and baseball, face the risk of ulnar collateral ligament injury. It is also common in those participating in gymnastics, soccer, and wrestling.

Tommy John surgery implants a graft tendon in face of the ligament in a figure-eight pattern and reconstructs the connection between the bones in the elbow joint.

Who is a candidate for Tommy John surgery?

A patient is recommended for Tommy John surgery only when his ulnar collateral ligament injury does not improve with non-surgical treatment. Many doctors prefer to suggest it only when the patient’s professional or sports performance require grueling overhead or throwing activities, as the injury does not impact normal daily activities.

How is Tommy John surgery performed?

Tommy John surgery involves taking a tendon from forearm, knee, thigh, wrist, foot, or other body parts and implanting the same to replace ulnar collateral ligament. Cadaver tendons are also used. Tunnels are drilled in both forearm and upper arm bones after the elbow is opened up. Surgeons may perform an arthroscopy prior to Tommy John surgery to asses if bone spurs, loose bodies, or arthritis causing the elbow disorder. Flexor muscles are split to access the area.

The graft tendon is woven into them and the ulnar collateral ligament reconstruction is performed. Any remaining portion of the original ligament is attached to the reconstructed ligament.

A number of techniques are used during ulnar collateral ligament depending on the requirement.

  • Ulnar nerve rerouting only when there is previous damage to it
  • Docking technique or drilling three holes in the medial epicondyle and connecting it to the two holes in the ulna using the graft tendon.
  • Figure eight technique or drilling two holes on each side and weaving the graft tendon into them.

How long does Tommy John surgery take?

It takes about 60 to 90 minutes.

Do I need to stay at the hospital after Tommy John surgery?

Overnight stay at the hospital is recommended. Most patients remain in the hospital on the day of operation and are discharged next day after a thorough check up.

What are the restrictions following Tommy John surgery?

  • Keep the incision bandage clean and dry
  • No showering for 3 days
  • No elbow movement for a week
  • Rest for 2 weeks
  • No driving for 6 weeks
  • Wear an elbow splint for 10 days
  • Keep the elbow elevated to control swelling
  • Keep the elbow on a pillow while sitting

What kind of rehabilitation is needed following Tommy John surgery?   

  • 1-7 Days: Squeeze a soft ball, avoid elbow movement, wear a splint
  • 2-4 Weeks: Wear a sling, progressive full range of motions, no need for post-operative immobilization, progress to active motion from passive motion
  • 5-8 Weeks: Start full range of elbow motion, workouts involving forearm and shoulder, start using lightweights
  • 9-12 Weeks: Workouts for upper and lower extremities, avoid direct stress to elbow, do strengthening exercises
  • 13-16 Weeks: Start gradual throwing activities required for sports participation, enhanced flexibility, conditioning, coordination, and strengthening
  • 17 Week to 6 Months: Extended throwing sessions with rigorous practice
  • 7 Month to 10 Month: Progressive increase in speed, strength, distant throwing, and flexibility workout. Focus on body mechanics.
  • 10-12 Months: Start normal sports

How long is the recovery period following Tommy John surgery?

Patients recover from surgery in 6 to 8 weeks. Full shoulder and elbow motions are attained in 6 to 8 months without pain and with adequate biomechanics in another two months. It takes a year with proper rehabilitation to return to the original elbow strength and ability.

What are the potential complications of Tommy John surgery?

Surgical complications may lead to blood vessel or injury and infection. Similarly, the ulnar nerve may be injured. All these can be avoided by using the right surgical technique. Temporary pain, swelling, and stiffness are usual after Tommy John surgery and continue for a few days after the operation.

References

Cain EL, Andrews JR, Dugas JR, et al. Outcome of ulnar collateral ligament reconstruction of the elbow in 1281 athletes: Results in 743 athletes with minimum 2-year follow-up. Am J Sports Med. 2010;38(12):2426-2434.

Ahmad CS, Grantham WJ, Greiwe RM. Public perceptions of Tommy John surgery. Phys Sportsmed. 2012;40(2):64-72.

Makhni EC, Lee RW, et al. Performance, Return to Competition, and Reinjury After Tommy John Surgery in Major League Baseball Pitchers: A Review of 147 Cases. Am J Sports Med. 2014;42(6):1323-1332.

Jiang JJ, Leland JM. Analysis of pitching velocity in major league baseball players before and after ulnar collateral ligament reconstruction. Am J Sports Med. 2014;42(4):880-885.

Erickson BJ, Gupta AK, Harris JD, et al. Rate of return to pitching and performance after Tommy John surgery in Major League Baseball pitchers. Am J Sports Med. 2014;42(3):536-543.

Purcell, Derek B; Matava, Matthew J; Wright, Rick W (2007). “Ulnar Collateral Ligament Reconstruction”. Clinical Orthopaedics and Related Research 455: 72–7.

Osbahr DC, Cain EL, et al. Long-term Outcomes After Ulnar Collateral Ligament Reconstruction in Competitive Baseball Players: Minimum 10-Year Follow-up. Am J Sports Med. 2014;42(6):1333-1342.

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