Tommy John surgery is a revolutionary orthopedic procedure for athletes that involves the reconstruction of a damaged ligament in the elbow. This operation is formally known as Ulnar Collateral Ligament (UCL) reconstruction. The procedure is typically reserved for high-level athletes who rely on repetitive, high-velocity overhead motions in their sport. It stabilizes the elbow joint, which is a necessary step for them to return to their prior level of competition.
The Origin Story: The First Procedure
The surgical technique that would become known as Tommy John surgery was first performed in September 1974. Orthopedic surgeon Dr. Frank Jobe pioneered the procedure on Major League Baseball pitcher Tommy John. At the time, the prospect of an athlete returning to professional sports after such an injury was considered highly unlikely. Dr. Jobe himself gave the procedure only an estimated one in 100 chance of success. Before this operation, a torn UCL was almost universally a career-ending injury for a pitcher. Despite the medical community’s skepticism, Tommy John was determined to attempt the experimental surgery to save his career. John missed the entire 1975 season for rehabilitation but famously returned to pitch for 14 more seasons after his successful surgery.
The Anatomy of the Injury
The Ulnar Collateral Ligament (UCL) is a thick band of connective tissue located on the inner side of the elbow. It connects the upper arm bone (humerus) to one of the forearm bones (ulna). The UCL acts as the primary restraint against a force called valgus stress, which tries to push the elbow inward during throwing. Repetitive, strenuous overhead movements, such as pitching, gradually stretch and weaken the ligament. When the UCL tears completely, the elbow becomes unstable, resulting in pain, decreased throwing velocity, and an inability to perform at a high level.
How the Procedure Works
The procedure replaces the damaged UCL with a tendon harvested from another part of the patient’s own body, which is called an autograft. Surgeons commonly use a tendon from the forearm, the hamstring near the knee, or occasionally the foot. The new tissue serves as a biological scaffold for a new ligament to form. The surgeon begins by making an incision on the inner elbow and carefully moving the surrounding muscles and nerves to access the damaged ligament. Small tunnels are then precisely drilled into the humerus and ulna bones at the ligament’s natural attachment points. The tendon graft is threaded through these tunnels and secured, often using a figure-eight pattern or a docking technique. This intricate weaving anchors the new ligament to the bones, providing the necessary stability for the elbow joint.
Transforming Sports Medicine
Tommy John surgery has changed the landscape of sports medicine by turning a career-ending injury into a treatable condition. The operation’s success rate for a full return to play is often cited as being between 80% and 95% for professional baseball players. This high success rate has made the surgery a standard option for elite athletes. The procedure’s application has also expanded beyond baseball pitchers to athletes in other sports that involve significant overhead stress, such as javelin, tennis, and volleyball. The recovery process is long and intensive, typically requiring 12 to 18 months of rigorous rehabilitation before a pitcher can return to full competition. The surgery allows athletes to not only return to their sport but often to pitch at the same, or even a higher, velocity than before the injury.