Elbow ligament reconstruction, also known as Tommy John surgery, is an orthopaedic surgical procedure that reconstructs the ulnar collateral ligament (UCL) in the elbow. The UCL is made up of an interconnected network of fibers that run from the medial epicondyle in the anterior aspect of the elbow to the posterior aspect of the humeral head and which stabilizes the elbow joint.

Injuries to the ligaments in the elbow are common in athletes who throw an object, such as a baseball. The most important of these ligaments is the ulnar collateral ligament. The surgery generally involves replacing the damaged ligament with a tendon from elsewhere in the body and attaching it to your arm bones with sutures or screws.

This procedure was introduced and first performed by Frank Jobe, M.D., on baseball pitcher Tommy John in 1974—hence the colloquial name Tommy John surgery.

If you’re experiencing these symptoms, you may be suffering from Ulnar Collateral Ligament (UCL) damage. This damage is most often pain to the inside part of the elbow while throwing, along with loss of velocity and accuracy.

Your surgeon might suggest Tommy John surgery when surgical treatment is required. This treatment generally involves a surgical graft to replace the ligament with a tendon from elsewhere in the body. The physician will most likely attach the tendon to the bones with sutures or screws to hold it in place.

Your surgeon will first do a brief medical history and physical examination to assess elbow mobility, strength, alignment, and stability. While X-ray can rule out other potential diagnoses (fractures and arthritis), X-ray cannot directly show a LUCL tear, however your orthopedic surgeon would be able to see the physical abnormalities of lesions and complete ruptures of the elbow ligaments.

MRI scans are good at looking at soft tissues, such as ligaments, tendons and can pick up injury to the LUCL either partial or full thickness tears. An MRI arthrogram is the most sensitive imaging study to detect elbow ligament tears. This is where a special dye is injected into the elbow, and then an MRI is done.

Fluoroscopy is a technique used by surgeons to evaluate the bony anatomy of your elbow. If imaging is inconclusive, your surgeon may elect to evaluate your elbow with a live x-ray in the operating room. As ligament instability can be subtle, evaluating the bony anatomy while actively moving the elbow is often useful

Ligament reconstruction

As part of the treatment plan for a ligament reconstruction, your surgeon will excise a donor tendon from either the forearm or below the knee. The graft is drilled into the upper arm and forearm bones and anchored using special sutures. The surgery can be performed arthroscopically or open depending on the extent of damage and your surgeon’s preference.

You will be prescribed with a splint to support the elbow for several weeks after the surgery. You will need regular follow-ups, along with vocational rehabilitation, to ensure a faster recovery.

After surgery, you will have several precautions to make sure your recovery is at its highest level.

To ensure this, iced compresses should be applied to the elbow for a minimum of twenty minutes once every six hours. This will reduce swelling and relieve pain.

A splint that is strapped to the elbow will also be placed on you to protect the ligament while it is healing.

Avoiding complete extension, or straightening, of the elbow is recommended for four weeks, however some cushioning can be involved when extension of the arm is necessary.

Physical therapy is started two to three weeks after surgery and some form of therapeutic exercise will be necessary for four to six months.

Return to vigorous pushing and lifting activities with the arm is started around six months after surgery.

The most common risk to patients undergoing elbow ligament reconstruction surgery is the possibility of bleeding. Also, there is the risk of infection and nerve damage.

Although major complications from this surgery are rare, there is a chance of infection, wound healing problems and nerve injury, deep vein thrombosis and pulmonary embolism.

Elbow ligament reconstruction is a surgical procedure to repair the medial elbow structures and restore elbow stability.

This surgery can be performed on patients who have a tear in the medial elbow ligaments, which are commonly torn during sports and athletic competition. Surgical treatment is designed to restore medial stability of the elbow. This will help return patients back to full activity.

The aims of this procedure include restoring full movement in the elbow as well as alleviating pain experienced by the patient.