Tommy John Surgery
As the head team physician for the Chicago White Sox, I have extensive experience treating elbow ligament injuries in athletes and active individuals, particularly those involved in throwing sports. Medial ulnar collateral ligament (UCL) reconstruction, commonly known as Tommy John surgery, is a specialized procedure designed to restore elbow stability, function, and athletic performance for patients with UCL injuries. Our experienced surgeons use the latest techniques to help you return to play.
What is UCL Reconstruction?
The medial ulnar collateral ligament is a critical structure in the elbow that provides stability during overhead and throwing motions. Injuries to the UCL often occur due to repetitive stress, particularly in athletes like baseball pitchers, javelin throwers, and other high-demand overhead athletes. In some cases, it can tear acutely with a single throw/pitch or with trauma, such as in wrestling or football. When the UCL is severely torn or damaged, surgical reconstruction may be necessary to restore function, eliminate pain, and prevent further instability. Newer techniques, such as ligament repair, may facilitate an earlier return to play. In addition, comprehensive repair and reconstruction (hybrid) reconstruction may provide better durability of the reconstructed ligament.
Signs and symptoms of UCL injuries
Common symptoms that may indicate a UCL injury include:
- Pain or tenderness on the inner side of the elbow.
- A “pop” or tearing sensation during a throwing motion.
- Swelling or bruising in the elbow joint.
- Decreased velocity or accuracy when throwing.
- Weakness or instability in the elbow during physical activity.
- Numbness or tingling in the ring and small (pinky) finger
- Decreased range of motion or stiffness in the elbow
If you experience these symptoms, you must consult a specialist for an accurate diagnosis and treatment plan.
Why choose Midwest Orthopaedics at Rush for tommy john surgery?
With extensive experience in UCL reconstruction, we provide individualized care that combines advanced surgical techniques with a comprehensive rehabilitation program to optimize outcomes. We have been team physicians for the Chicago White Sox for over 20 years, professionally treating athletes with elbow injuries. Many of our physicians have been heavily involved in research into the causes of UCL tears, injury prevention, and new surgical techniques, shaping the current knowledge and approach to managing these injuries.
Our approach to UCL reconstruction
Pre-Surgical Evaluation
We begin with a thorough assessment, including imaging studies such as MRI or ultrasound, to confirm the diagnosis and evaluate the extent of the injury.
A history is obtained from the player, including any injury event, the duration of symptoms, type of symptoms, and effect on athletic performance. In addition, understanding the patient’s goals of returning to sports, years of sport remaining, and desire to play “at the next level,” whether that is high school, college, minor, or major leagues, is critical to treatment decisions. Time of season is considered in regards to minimizing time missed from sport.
MRI evaluation of the elbow requires high-quality scans with dedicated sequences to completely evaluate the ligament and surrounding structures. A specialized view called a FEVR view is used to better visualize the ligament and assess the amount of instability in the joint. It is an imaging sequence not routinely obtained in other centers but considered standard for all our throwing athletes. Lastly, an ultrasound can dynamically evaluate the amount of laxity in the joint by comparing the injured side to the opposite normal side. Ultrasound requires a physician trained in the scanner with experience visualizing the ligament in throwing athletes. Our use of these complex imaging tools helps us to thoroughly evaluate the player and provide the most comprehensive recommendations for treatment using the most advanced techniques available.
Surgical Expertise
Surgical management of UCL injuries has evolved significantly over the past decade. The ligament must first be evaluated to determine the location and extent of the tear. In addition, the overall health of the elbow must be assessed as alternate pathologies, such as bone spurs, muscle strains, or cartilage damage, may also be present. In younger patients, the ligament may tear on one side or the other (proximal or distal attachment), but the remainder remains intact and healthy. In other cases, the ligament may tear in the middle or is highly degenerated, leaving only poor-quality tissue to work with.
Repair with Internal Brace
This procedure is indicated for patients with a high-grade partial tear or complete tear of the ligament at either the proximal (humerus) or distal (Ulnar) side of the ligament. During the surgery, the ligament is exposed, and the old ligament is incised to determine the area of injury and evaluate the joint surfaces. The ligament is then repaired using sutures and an anchor. The repair is then augmented using an “internal brace,” a suture tape coated with collagen laid over the top of the repair and fixed with anchors. In this way, the suture protects the ligament to facilitate healing.
Reconstruction
During the procedure, our surgeons use a tendon graft—most commonly harvested from your wrist or hamstring—to reconstruct the damaged ligament. Similar to the repair, the native ligament is first incised and repaired. Next, the graft is carefully anchored to the bone by drilling tunnels in the bone to allow the graft to heal. The ligament is tensioned with the arm in a position of function.
Hybrid Reconstruction
In this procedure, the two techniques are combined. The ligament is repaired, collage tape is added to augment the repair, and then a graft is layered over the top.
Customized Rehabilitation
The surgery is only the first step in the recovery from your procedure. Post-operative care is critical to your recovery. Our dedicated rehabilitation team designs a personalized plan to help you rebuild strength, restore range of motion, and safely return to your sport. We have built an expert throwing program to take players from surgery to complete their return to competition. The program begins with standard physical therapy to control swelling and mobilize the joint while protecting the repair. The second phase facilitates strength recovery in the upper and lower body.
This includes the scapula muscles, rotator cuff, arm muscles, and grip strength. The lower body is critical to creating a stable base for throwing and facilitating power. Therefore, core and proximal leg strengthening exercises prepare a player for a successful return to sport. Metrics regarding the range of motion and strength recovery, along with timelines for ligament healing, are used to determine readiness to return to throw. Typical return-to-throw programs are initiated 4 months following a repair and six months following a reconstruction.
The athlete progresses through a customized throwing program in the final recovery phase. Our program is designed to slowly increase the load on the ligament to facilitate healing and remodeling of the collagen fibers. Care has been taken to avoid large spikes in workload, which can be harmful or risk re-injury. Gradual increases in workload using controlled distance and velocity with interspersed periods of rest (d-load) are integrated. At the same time, continued strengthening and range of motion exercises are used on nonthrowing days to allow the athlete to progress.
Motion Analysis
Once an athlete returns to throwing off a mound at approximately 80% of normal velocity, a customized motion analysis assessment is utilized to evolve the biomechanics of an individual’s throwing motion. Identifying areas of concern or abnormal motion patterns allows correction of these flaws to facilitate performance and help minimize the risk of re-injury to the elbow or other areas, such as the shoulder.
Recovery timeline
Recovery from UCL reconstruction is a gradual process, typically taking 9 to 18 months for athletes to return to competitive play. The recovery timeline includes:
- First 6 Weeks: Surgical site protection with a brace and limited motion exercises.
- 6 to 12 Weeks: Gradual strengthening exercises and increased range of motion.
- 3 to 6 Months: Progressive conditioning and sport-specific training.
- 9 to 18 Months: Full return to throwing and competitive sports, with ongoing monitoring to prevent re-injury.
Supporting athletes every step of the way
At Midwest Orthopaedics at Rush, we recognize the mental and physical challenges of recovering from a UCL injury. The road to recovery can be lonely. Therefore, we frequently engage sports psychologists to help athletes cope with the stress of the recovery process. Our team works closely with athletes, coaches, and trainers to ensure a safe and effective return to play. We also provide education and preventative strategies to reduce the risk of future injuries.
If a UCL injury has sidelined you, trust the experts at Midwest Orthopaedics at Rush to provide the specialized care you need. Our team is dedicated to helping you get back to doing what you love—stronger and more confident than ever.
Ready to see an elbow specialist?
If you have sustained an elbow injury or have been diagnosed with an elbow ligament injury (UCL tear), go where the pros go. We perform more UCL repairs or reconstructions than anyone in Chicago. Call us today to schedule a consultation.
