Can You Provide Information on Treatment for a Torn UCL Using the Tommy John Surgery?

Dear Dr. Millett,

I need Ulnar Collateral Ligament Reconstruction Surgery (Tommy John Surgery). I was wondering if you could answer some questions I have on the topic of UCL surgery? I’m curious to know how athletes get this injury and how is the UCL surgery performed? What advancements have been made to the procedure since it was first developed and what is rehabilitation like?

Thank you.



Many athletes will suffer ligament injuries that can be directly related to over-use. A ligament is a moveable structure that holds bones together and helps to control the movement of joints. The ulnar collateral ligament (UCL) is located on the inside (medial side) of the elbow. Injuries such as a torn UCL tend to occur in throwing athletes where repetitive motion occurs. Less commonly it may occur with a single traumatic event. This injury is extremely uncommon in non-throwing athletes. Tommy John was a pitchers for the Dodgers who was the first professional baseball player to successfully recover from this injury and the subsequent surgery. He actually had more wins after the surgery, than before! The surgery has been named after him: Tommy John Surgery.

Obviously UCL tears and injuries are most common among baseball players, especially pitchers. But it is not uncommon for tennis players and other racquet sports participants to tear their UCL. At times we may see this injury in athletes who play contact sports but they frequently will not need surgical repair.

When non-surgical treatment fails, UCL tears may need to be reconstructed surgically with an ulnar collateral ligament reconstruction surgery. To do so we take a tendon from another part of the body, usually one of the hamstring tendons from the knee or a cadaver ligament, and we use this to rebuild the torn UCL. This particular procedure has an 85-90% success rate and has enabled many overhead athletes to get back to competition. Because we have a better understanding of the anatomy and have adapted better surgical procedures the surgery itself has evolved into a much more reliable procedure.

After surgery it can take up to a year to achieve the full benefits of surgery but most throwing athletes can resume competition at about 7 months. But during this year it is very important that the athlete seeks physical therapy and continues with this program until the new UCL is completely healed. It is advised that once stability is achieved through physical therapy, the athlete begins a throwing program to regain his power and endurance in the arm. Precision usually returns after 8 months.