Athletes who throw hard are at high risk for tearing the ulnar collateral ligament (UCL), which is located on the inside of your elbow. If you tear your UCL, you may need to replace it with a graft from elsewhere in your body — a procedure known as Tommy John surgery. Tommy John surgery is named after the first Major League baseball pitcher who had his UCL replaced in this manner. Sidenote: Houston Astros pitching coach Brent Strom was the second!
David Lintner, MD, Chief of Sports Medicine at Houston Methodist Orthopedics & Sports Medicine and director of the sports medicine fellowship in Houston and Baytown, Texas, is an expert at Tommy John surgical UCL reconstruction for athletes. He’s the team physician for the Houston Astros but treats and reconstructs the UCL for everyone from school athletes to weekend warriors. In fact, he does more “TJ” procedures than any other surgeon in the Houston region.
If you’re scheduled for Tommy John surgery, you probably have a lot of questions. How do you prepare? What happens during the procedure? And how long does it take to recover? The answers are below.
Preparing for Tommy John surgery
Dr. Lintner performs Tommy John surgery at the hospital. You will be under general anesthesia during the operation. The surgery takes about 1 hour.
Although you’ll be released the same day, you need to arrange for someone to pick you up from the hospital. You’ll be groggy from anesthesia and won’t be able to drive yourself home.
You should also pre-plan your meals and household help during the early stages of your recovery. You won’t be able to move your elbow for about two weeks after your surgery.
You may also need to discontinue blood-thinning medications and certain supplements such as aspirin and ginseng. If you smoke, you should also stop before your surgery. We discuss your preoperative prep with you, but you can always call us if you have a question.
Two incision sites
In addition to repairing your UCL, Dr. Lintner must also remove a tendon from another part of your body to create the graft. Common sites to take tendon grafts include:
- Palmaris longus tendon (forearm)
- Hamstring tendon (leg)
The graft site will also be sore after your operation, and you must take care not to stress that area, either.
What happens during Tommy John
During your UCL reconstruction, Dr. Lintner first harvests the tendon graft. He then makes a 3-4 inch incision on the inside of your elbow. He cleans your elbow joint, removing any damaged tissue or bone fragments.
Once he’s moved aside any muscles or tissues that block your UCL, he then assesses the damage. He will repair your torn ligament and then add the graft to the repaired UCL to reinforce the repair. To do this, he makes holes into the bones that your UCL is attached to — your upper and lower arm bones. He threads the graft through the holes and secures it with either anchors, sutures, or screws depending on your individual anatomy.
To help your graft heal, he adds BioECM® amniotic membrane graft. This brings healing factors derived from stem cells that are thought to accelerate your healing. These technologies help restore your ability to throw and perform your sport at a peak level.
In some cases, he may also add platelet-rich plasma (PRP) to accelerate healing. He creates the PRP serum from a simple blood draw from your arm.
Take time to recover
You start physical therapy (PT) as quickly as possible to stretch and strengthen the UCL graft. You should regain your full range-of-motion by 6 weeks.You have to wear an elbow brace for about a month after your surgery. Athletes need a longer recovery and rehab period for Tommy John Surgery than nonathletes due to the high stresses that throwing creates. So the time to return to baseball activities will be about 12 months.
There are newer technologies, including ligament repair with reinforcement with a synthetic material (Arthrex Internal Brace) instead of a tendon. This has a shorter recovery time. Some tears are appropriate candidates for this technique, but not all. Check out our upcoming blog post about this topic!
If you have elbow pain, trust your UCL to someone with a history of restoring elbow and throwing function with Tommy John surgery. Call our office nearest you today in Houston or Baytown, Texas.