Tommy John surgery (UCL reconstruction): Recovery, risks, success rate Health ConditionsHealth ConditionsAlzheimer's & DementiaAnxietyArthritisAsthma & AllergiesBreast CancerCancerCardiovascular HealthCOVID-19Dermatology & SkincareDiabetesEnvironment & SustainabilityExercise & FitnessEye HealthHeadache & MigraineHealth EquityHIV & AIDSHuman BiologyInflammatory Bowel DiseaseLeukemiaLGBTQIA+Men's HealthMental HealthMultiple Sclerosis (MS)NutritionParkinson's DiseasePsoriasisSexual HealthWomen's HealthDiscoverNewsLatest NewsOriginal SeriesMedical MythsHonest NutritionThrough My EyesNew Normal HealthPodcastsHow to understand chronic painWhat is behind vaccine hesitancy?The amazing story of hepatitis C, from discovery to cureNew directions in dementia researchCan psychedelics rewire a depressed, anxious brain?Why climate change matters for human healthToolsGeneral HealthDrugs A-ZHealth HubsHealth ToolsBMI Calculators and ChartsBlood Pressure Chart: Ranges and GuideBreast Cancer: Self-Examination GuideSleep CalculatorHealth ProductsAffordable Therapy OptionsBlood Pressure MonitorsDiabetic SuppliesFitness TrackersHome GymsGreen Cleaning ProductsHow to Shop for CBDQuizzesRA Myths vs FactsType 2 Diabetes: Managing Blood SugarAnkylosing Spondylitis Pain: Fact or FictionConnectAbout Medical News TodayWho We AreOur Editorial ProcessContent IntegrityConscious LanguageNewslettersSign UpFollow UsMedical News TodayHealth ConditionsDiscoverToolsConnectSubscribe What to know about Tommy John surgery UCL reconstruction Medically reviewed by Daniel Wiznia, MD — By Mary West on June 29, 2022Tommy John surgery is a common term for ulnar collateral ligament (UCL) surgery, which is an operation on the elbow joint. It involves taking a ligament from another part of the body and using it to reconstruct a torn UCL. This ligament is the most important soft tissue stabilizer for the elbow during a baseball pitcher’s overhead throwing motion. When it tears, it can cause significant problems. A 2020 study in the journal Current Reviews in Musculoskeletal Medicine found that the procedure has a low complication rate and a high return-to-play rate of 80–95%. Despite the high success rate, some people who undergo the surgery find that it results in some negative effects on pitching performance. Approximately 20% of Major League Baseball (MLB) pitchers cannot return to their pre-injury level of play following recovery, which may take 12–18 months. Read more to learn about what Tommy John surgery is, who needs it, and the success rates. What is Tommy John surgery Share on PinterestTana Teel/StocksyThis surgical procedure dates back to 1974 when Dr. Frank Jobe performed it on MLB pitcher Tommy John. It initially involved replacing or reconstructing the torn UCL at the elbow with a ligament from the wrist. The replacement ligament is called a graft. Over the years, surgeons have modified the procedure in various ways. Sometimes, using grafts from other parts of the body can lead to better outcomes. Approximately 26% of MBL pitchers undergo Tommy John surgery during their pitching career. Who needs it Some people with an injury to the UCL need Tommy John surgery. The long-term buildup of microtrauma usually causes the injury, but in some cases, a sudden rupture may be responsible. These injuries lead to pain and a reduction in pitching performance, which may take the form of decreased accuracy, velocity, and strength. The criteria that determine whether someone needs the surgery include having a complete tear in the UCL or a stretched UCL and not achieving relief with nonsurgical treatments. An individual with a low or medium grade partial tear of the ligament will often respond to a combination of rest and nonsurgical treatments, such as:taking anti-inflammatory medicationsicing the affected areadoing range-of-motion exercises for the muscles that bend the elbow and turn the forearm palm upwearing a brace or splint during sleep How it works The UCL is an important soft tissue stabilizer for the elbow joint during overhead throwing. As the surgery reconstructs this torn ligament, it reduces pain and restores stability and range of motion. These effects often reinstate function to the extent that baseball pitchers may return to competitive sports. Recovery The exact time to recover will vary among individuals. However, rehabilitation after surgery is typically as follows:Phase one (weeks 1–3): During the first week, doctors put the elbow in a device that keeps it immobile. Afterward, a person may do gentle range-of-motion exercises with a hinged brace.Phase two (weeks 4–8): The range-of-motion exercises continue, but the rehabilitative focus is on restoring strength. This involves exercises using weights to strengthen the muscles that stabilize the elbow, shoulder joints, and shoulder blade. A person will start with 1-pound (lb) weights and increase these by 1 lb each week.Phase three (weeks 9–13): The primary focus is on increasing flexibility. This entails activities such as manual resistance exercises and drills involving changing stabilization. A sports-specific program begins at week 12.Phase four (weeks 14–26): The main focus is on restoring throwing performance. A person will begin with short-toss throws and gradually advance to long-toss throws. In the final weeks, the program progresses to game simulation that includes throwing from the mound. The recovery time before a baseball player can return to the game may be as long as 12–18 months for MLB pitchers. This time frame may mean that a player has to miss one or two competitive seasons. However, this lengthy recovery is necessary for the maturation of the graft. Success rate Doctors view Tommy John surgery as a procedure with very good outcomes. It has return-to-play rates in the range of 80–95%. However, after undergoing Tommy John surgery, about 20% of MLB pitchers cannot attain the same level of play. This is despite modern technologies that have decreased complication rates and increased return-to-sport rates. Some data suggest that the surgery affects pitching performance by leading to:reduced elbow extension, or straightening out, after ball releasemedialization of sinker, fastball, and curveball, which means that these pitches travel closer to a pitcher’s midline than intendedincreased earned run averageincreased walks plus hits per inning pitched The rate of revisions — which is when a surgeon needs to operate again to correct the existing graft — is currently low, in the range of 1–7%. Benefits The main benefit of Tommy John surgery is the restoration of a person’s ability to resume their role as a baseball pitcher. According to a 2020 study, prior to the advent of Tommy John surgery, a tear in the UCL ended a person’s baseball career. Complications Complications are rare, but they may include:rupturestiffnesspainweaknessulnar nerve symptoms Summary Tommy John surgery involves reconstructing the UCL by grafting a ligament from another part of the body. The criteria for needing the surgery include having a complete tear in the UCL or a stretched UCL that is not responding to nonsurgical treatment. The benefits of the surgery stem from the fact that it reconstructs the UCL, which is vitally necessary for elbow stability. This restoration of stability has enabled many people who have undergone the surgery to return to pitching. Last medically reviewed on June 29, 2022SurgeryBones / OrthopedicsSports Medicine / Fitness 5 sourcescollapsedMedical News Today has strict sourcing guidelines and draws only from peer-reviewed studies, academic research institutions, and medical journals and associations. We avoid using tertiary references. We link primary sources — including studies, scientific references, and statistics — within each article and also list them in the resources section at the bottom of our articles. You can learn more about how we ensure our content is accurate and current by reading our editorial policy.Carr, J. B., II, et al. (2020). Elbow ulnar collateral ligament injuries: Indications, management, and outcomes [Abstract].https://pubmed.ncbi.nlm.nih.gov/32112818/Erickson, B. J., et al. (2015). Ulnar collateral ligament reconstruction: Anatomy, indications, techniques, and outcomes.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4622381/Jensen, A. R., et al. (2020). The history and evolution of elbow medial ulnar collateral ligament reconstruction: From Tommy John to 2020.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7251039/Mayo, B. C., et al. (2021). Preventing Tommy John surgery: The identification of trends in pitch selection, velocity, and spin rate before ulnar collateral ligament reconstruction in Major League Baseball pitchers.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8209837/Torres, S. J., et al. (2021). Ulnar collateral ligament repair of the elbow - biomechanics, indications, and outcomes.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7991021/FEEDBACK:Medically reviewed by Daniel Wiznia, MD — By Mary West on June 29, 2022 Latest newsWhat sets 'SuperAgers' apart? Their unusually large neuronsOmega-3 may provide a brain boost for people in midlifeSeasonal affective disorder (SAD): How to beat it this fall and winterCDC: Monkeypox in the US 'unlikely to be eliminated in the near future'Why are more women prone to Alzheimer's? New clues arise Related CoverageWhat to do about a hyperextended elbowMedically reviewed by William Morrison, M.D. A hyperextended elbow can occur when the elbow moves outside its normal range of motion. 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