Introduction
Tommy John Surgery is the colloquial phrase used to describe an ulnar collateral ligament reconstruction. The procedure is performed to repair or reconstruct the ulnar collateral ligament in case of an injury causing the ligament to tear. It is a surgical graft procedure that involves taking a tendon graft from elsewhere in the body. The graft may also be taken from a different donor.
What Is Ulnar Collateral Ligament Surgery?
The ulnar collateral ligament is the ligament present on the inner part of the elbow that keeps the elbow joint in its place and is fundamental for its stability. It connects the humerus, the longest bone in the upper extremity, to the ulna, one of the two bones in the forearm. Activities that involve constantly throwing, especially while playing sports, can lead to a tear in this ligament.
Tommy John surgery involves a ligament graft taken either from a donor site of the patient or from a consenting donor to replace the damaged ligament as a result of overuse, commonly seen in individuals involved in professional athletics. Very few cases of ulnar collateral ligament tear have been reportedly caused by traumatic events. The surgery aims to alleviate the pain, keep the elbow intact and restore the range of motion and stability, as close as possible to as it was prior to the injury.
Why Is the Surgery Named So?
The surgery is named after Thomas Edward John, who was fondly called Tommy John.
Tommy John, a baseball player, experienced a setback in his career in 1974 when he suffered from ligament damage in his elbows and had to undergo a procedure that had never been performed before to repair and reconstruct his ulnar collateral ligament. The success of the procedure revived the functionality of his pitching arm and, by extension, his athletic career as a whole. This surgery was first performed by Dr. Frank Jobe on Tommy John, and the procedure has been colloquially named as such ever since.
What Is Tommy John Surgery?
Tommy John surgery or the reconstruction of the ulnar collateral ligament is a procedure performed in cases where an overhead throwing athlete sustains a high-grade injury to the ligament in question. A tendon graft obtained from either the patient’s own forearm or hamstring muscle or that from a consenting donor is used to replace the damaged ligament providing a new, strong ligament with reduced pain, enhanced range of motion, and pre-injury levels of functionality.
How Does an Athlete Feel When the Ulnar Collateral Ligament Tear Occurs?
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Pain in the medial portion of the elbow.
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Loss of velocity and accuracy while throwing motions.
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The pain occurs during the “layback” or “late cocking” phase.
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The feeling of pop during the throwing movement.
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Gradually aggravating the pain.
What Are the Criteria to Undergo Tommy John Surgery?
Individuals involved in sports that experience the aforementioned symptoms satisfy the criteria for undergoing surgery. Inability to throw, gradually or immediately aggravating pain, and loss of range of motion are the principal indicative factors for this surgery. Traumatic cases very rarely occur that require this form of surgical repair.
What Is the Procedure for Tommy John Surgery?
The surgery begins by harvesting a healthy tendon either from a donor site of the patient or from that of a consenting donor, which is intended to function as the new ligament. The graft is usually obtained from a tendon of the forearm or the hamstrings. The torn portion of the ligament is then identified, and new drill holes are created to house the grafted tendon. This is usually done in the ulna and humerus, which is the natural attachment point of the ligament. Sutures are placed and threaded through the drill holes created priorly in a figure of 8 patterns and then tightened at the proper position.
What Is the Duration of the Surgical Procedure?
Tommy John surgery is usually an outpatient procedure and takes about 45 minutes to an hour for completion. Depending upon the presence of additional injuries, the procedure may require a prolonged duration. The decision is based upon the clinical history and physical examination done by the consulting surgeon.
What Are the Postoperative Risks?
Although the risks of Tommy John surgery are very low, as with any surgical procedure, there are some considerations to be taken into account that may impair postoperative recovery and overall healing. The common risks associated with this surgery are as follows;
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Damage to the ulnar nerve.
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Infection of the surgical site.
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Fracture of the involved bone, ulna, or humerus.
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Numbness and paresthesia at the surgical site
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Future injuries to the newly placed ligament graft.
What Is the Postoperative Recovery Period?
Recovery largely depends upon the athlete. Most individuals recover within around five to seven months following the procedure. Some cases may require around a year to 15 months postoperatively and possibly longer. The average recovery phase period is calculated to be between nine months to a year.
How Successful Is Tommy John Surgery?
The success rate of this procedure is over 90 %. Newer and more improved techniques have been introduced, such as the ‘docking technique’ that is both strong and reliable. The athletes are able to return to their respective competitive fields within a stipulated time period, and no serious harm occurs to their career or tenure, so to speak.
Is Postoperative Physiotherapy Helpful?
Some athletes have reportedly claimed to be able to throw faster after this procedure. This feat is the postoperative physical and occupational therapies and strengthening exercises, as recommended by specialists for the affected arm. A strong and reconstructed ligament allows the athlete to exert maximum effort while throwing without experiencing pain or any other symptoms.
Can Therapies Increase or Improve an Unaffected Ulnar Collateral Ligament?
Several short-term studies have suggested that the ulnar collateral ligament increase in thickness from repeated throwing motions and a regimen of regular exercise. However, the proper balance between exercise and rest to enhance the strength of the ligament is still obscure, and more long-term studies are warranted in this field to answer this question conclusively.
Can Ulnar Collateral Ligaments Heal Nonsurgically?
Although a ligament tear requires surgical intervention and graft placement, certain injuries may heal nonsurgically. The location and the severity of the injury, however, must be taken into consideration. Low-grade injuries may require rest and therapy; however, in the case of high-grade injuries, nonsurgical healing may not be so fruitful.
Conclusion
Tommy John surgery is commonly performed in athletes as they are more prone to ulnar collateral ligament injuries. Patients undergoing this procedure have a good prognosis and can usually return to their sport after physical therapy and rehabilitation. Although a ligament tear requires surgical intervention and graft placement, certain injuries may heal nonsurgically.
