Tommy John Surgery

Ulnar Collateral Ligament Reconstruction

Elbow injuries are common among athletes in baseball, tennis, and football, as well as in professionals like mechanics, construction, and house painting. When an injury tears the ulnar collateral ligament (UCL) that connects the ulna (lower arm bone) to the humerus (upper arm bone), UCL surgery may be required to repair it.

The first UCL repair was done in 1974 on Tommy John, a starting pitcher for the Los Angeles Dodgers. He was the first MLB pitcher to return to the game following elbow surgery, and he won 164 games over the next 14 seasons. Ulnar collateral ligament repair has been known as Tommy John surgery ever since. The surgery has proven highly successful at restoring strength and function, rescuing the careers of over 2,500 professional baseball players and other athletes.

What is Tommy John Surgery?

Tommy John surgery is the common name for ulnar collateral ligament reconstruction, a procedure used to repair a torn or damaged UCL in the elbow. The UCL is essential for stabilizing the elbow during overhead motions like throwing or swinging. When the ligament is injured — typically due to overuse or trauma — Tommy John surgery replaces the damaged ligament with a tendon graft or a piece of tendon from another part of the body, typically the hamstring or the extensor of the big toe.

The tendon graft may come from your body or a donor. The surgeon threads the tendon graft through tunnels drilled in the humerus and ulna to restore the joint’s stability. Over time, the graft “ligamentizes,” meaning the tendon gradually adapts and strengthens to function like a natural ligament, helping stabilize the elbow during movement.

While the surgery is best known in professional baseball, Tommy John surgery is equally effective for other athletes and individuals with UCL injuries that don’t respond to conservative care.

Who Can Benefit from the UCL Surgery?

UCL surgery is most commonly performed on athletes who place repetitive stress on their elbows, particularly through repeated overhead throwing motions, like pitching a baseball or serving at tennis. Repeatedly engaging in these motions can cause the specific injury that UCL repairs address. Javelin throwers, quarterbacks, construction workers, and house painters, among other professions, may also injure their UCL and benefit from Tommy John surgery.

UCL surgery is generally recommended when:

• The ulnar collateral ligament has been partially or completely torn
• Conservative treatments, including rest, physical therapy, or steroid injections, have failed
• The patient intends to return to a high level of performance or activity

Tommy John surgery is best known in sports because that is where this specific injury most often occurs. The surgery is also effective for non-athletes suffering from persistent elbow instability or pain due to UCL damage.

Risks and Complications of Tommy John Surgery

The success rates for Tommy John surgery are very high, particularly for patients who are genuinely dedicated to their physical therapy. However, as with any surgery, there are some risks with UCL repair. Potential complications include infection, nerve irritation, elbow stiffness, or adverse reactions to anesthesia. In rare cases, the new tendon may fail to heal properly, requiring revision surgery.

Some patients may experience lingering pain or reduced range of motion. While most athletes regain full function, and some insist they feel stronger after Tommy John surgery, a small percentage do not return to their previous performance level. Choosing an experienced orthopedic surgeon and committing to post-surgical rehabilitation are essential for reducing risks and achieving the best possible outcome.

Ulnar Collateral Ligament (UCL) Surgery: What to Expect

UCL surgery is typically performed under general anesthesia on an outpatient basis. The procedure takes about one to two hours, and your arm will be placed in a splint to protect the elbow and allow the incision to heal. During this period, patients may be encouraged to start making gentle movements of the wrist, hand, and shoulder under guidance.

Within the first week following Tommy John surgery, most patients transition to a range-of-motion brace that can be gradually adjusted to allow for more elbow movement as healing progresses and joint stiffness is addressed. Achieving full elbow extension early on is key. Around six weeks post-op, supervised strengthening exercises begin. A complete rehabilitation program can take nine to 12 months, especially for elite athletes aiming to return to competition.

At Hoag Orthopedic Institute, your sports medicine surgeon and orthopedic physical therapy team will work together to create a personalized recovery plan tailored to your goals and activity level.

Tommy John Surgery Recovery and Rehabilitation

Recovery from Tommy John surgery typically takes 12 to 18 months, with a structured rehabilitation plan playing a critical role in successful outcomes. During the first several weeks, patients gradually regain their range of motion while protecting the healing tendon graft. Physical therapy focuses on gentle exercises for the wrist, hand, and shoulder, progressing to elbow mobility.

After about six weeks, patients begin strengthening exercises tailored to their individual needs. Strength and endurance training continue over several months, building joint stability and support around the elbow. Athletes who must throw overhead typically begin a supervised throwing program around four to six months after Tommy John surgery.

Consistent physical therapy and following up closely with your orthopedic care team are essential to reducing the risk of reinjury and achieving long-term success. At Hoag Orthopedic Institute, our rehab specialists work closely with our surgeons to customize every recovery plan for optimal performance and healing.

Why Choose Hoag Orthopedic Institute for Tommy John Surgery

At Hoag Orthopedic Institute, our nationally recognized orthopedic surgeons specialize in sports medicine, including advanced treatment for elbow injuries like ulnar collateral ligament reconstruction. They provide expert diagnoses and perform Tommy John surgery using the latest techniques to promote healing and optimize outcomes.

With our dedicated team of orthopedic specialists, fellowship-trained surgeons, and physical therapists focused on musculoskeletal health, we provide personalized care from initial consultation through Tommy John surgery rehabilitation.

Whether you’re a competitive athlete who wants to get back in the game or you simply long to move without pain, we’re committed to helping you restore your elbow strength, stability, and performance — so you can get back to doing what you love.