During the procedure, the orthopedic surgeon will replace the torn ligament with a tissue graft taken from one of the patient’s other tendons. Most commonly, tendons are taken from the wrist, forearm, toe, hamstring, hip, knee or Achilles tendon. In some cases, tissue from a cadaver (a person who has passed away) will be used. This is called an allograft. After the graft has been selected and removed from its current location, sutures are attached to both ends. Next, the surgeon makes an incision along the elbow joint and forearm so he or she can view and access the areas of the elbow and arm necessary to perform the procedure. Then, the surgeon drills holes in the ulna and humerus. The grafts are woven through the holes into their new location and attached to the graft in such a way that allows them to hold the elbow joint in position. Sometimes, to increase the strength and stability of the new ligament, parts of the original, torn ligament are reattached to the tendon graft. After this has been done, the incision is closed with sutures and the elbow is placed in a large bandage and splint.
While Tommy John surgery can help improve elbow instability caused by trauma, dislocation and deformity, athletes who play overhead sports that require throwing (such as college and professional level baseball pitchers) tend to be the most likely to undergo the surgery. Throwing motions that twist and bend the elbow put repetitive strain on the Medial Ulnar Collateral Ligament which, over time, can cause it to fray, tear or become unstable.
Patients with elbow instability who have tried conservative treatments such as rest, ice nonsteroidal anti-inflammatory drugs and physical therapy, without favorable outcomes, may be good candidates for surgery. Athletes who want to resume strenuous throwing may also benefit from the surgery.
A successful operation will improve or eliminate symptoms such as elbow pain during and after throwing activities.
Your orthopedic specialist will review your previous treatments and your current condition to determine if UCL Reconstruction would be a beneficial procedure for you. Once the decision to have the surgery has been made, your physician may suggest that you go through a complete physical examination to ensure you are in good enough health to have the operation. During this appointment your doctor may also ask you questions about your medical history, take X-rays, and create a list of all your medications and allergies.
During this visit, it is likely your surgeon will also walk you through what will happen during the procedure. Take the time to ask any questions you may have. Knowing what to expect the day of your operation will help to keep you at ease.
Depending on what type of anesthesia you will be receiving, you may be told not to eat or drink anything after midnight the night before your surgery. Your doctor may also request that you stop taking certain medications before to your procedure, however pre-operative instructions will vary from patient to patient.
On the day of your surgery, you may be asked to arrive a few hours before your operation. Before you are admitted, you will be asked to fill out paperwork. Next, you will be admitted, evaluated by an anesthesiologist and sedated with a general anesthetic. You will sleep throughout the duration of your operation and you will not feel any pain.
After the operation has been completed and the anesthesia has worn off, you will wake up in a hospital bed. The majority of people are discharged home after UCL reconstruction surgery.
Your arm will be immobilized with a splint and covered in a bulky dressing. Immobilization gives the surgical wounds time to heal and allows the tendon graft to become less fragile. You may be given medication to help ease the pain at the incision site. Heat and ice can also be used to manage discomfort. In the first few days following your surgery, try to keep your elbow elevated above your heart while sleeping or sitting to avoid swelling and pain. Stack a few pillows on top of each other to create an elevated platform.
If your doctor used sutures to close your surgical incision that do not dissolve on their own, you will need to have the sutures removed 10-14 days after your procedure if performed. Once your physician has told you that you no longer need to wear your immobilization splint, you will likely begin physical therapy to regain your strength and mobility.
The first few weeks following surgery, the new ligament graft is very fragile. It is important to follow any instructions your care provider has given you regarding immobilization and post-operative limitations. Also, following surgery, certain tasks may be difficult or painful to execute. Such tasks and limitations may include:
Physical therapy, sometimes referred to as “PT”, typically starts five to seven days after Tommy John Surgery. The tendon graft is very fragile following surgery and transforming it into a functioning ligament requires a slow and steady rebuilding process. Most patients will meet with their physical therapist one or two times per week, up to a year after their surgery. However, specific rehabilitation recommendations will vary from patient to patient.
Goals of physical therapy after Tommy John surgery include:
When you first start physical therapy, you will likely start off doing gentle exercise modalities such as:
Over time you will build up to more active rehabilitation exercises such as:
Your physical therapist may give you exercises to do at home between sessions. Keeping up with prescribed exercises is an important aspect of the healing process and may help to speed the rate of your recovery. Many patients who follow their physical therapy regime carefully are able to return to athletic activities within six months to a year after surgery. However, competitive throwing athletes may require up to a year of rehabilitation before returning to their sport.