Elbow UCL Reconstruction (Tommy John Surgery)

Who is a candidate?
Ulnar collateral ligament (UCL) reconstruction—commonly known as “Tommy John surgery”—is most often performed in overhead-throwing athletes, such as baseball pitchers, but can also be needed in other athletes or active individuals who place high stress on the inner elbow. Candidates typically have a torn or severely damaged UCL, causing pain, loss of throwing velocity, and instability. Surgery is generally considered when non-surgical treatments (rest, therapy, injections) fail to restore function.

What does the surgery involve?
In this procedure, the damaged UCL on the inner side of the elbow is replaced with a tendon graft, often taken from the patient’s own forearm, hamstring, or sometimes from a donor. The tendon is passed through tunnels drilled in the humerus (upper arm bone) and ulna (forearm bone) and secured in place, creating a new ligament that stabilizes the elbow. Additional procedures, such as ulnar nerve transposition (moving the nerve to prevent irritation), may be performed at the same time.

How is this different from other elbow surgeries?
Unlike elbow replacement (which is for arthritis or fractures) or arthroscopy (which focuses on cleaning out the joint), UCL reconstruction is specifically aimed at restoring stability in high-demand athletes. The goal is not just to reduce pain, but to allow athletes to return to competitive throwing and overhead sports at their prior level of performance.

What are the potential downsides or risks?
As with all surgeries, there are risks of infection, nerve irritation, or stiffness. The biggest concern is that some athletes may not regain their previous level of performance, even after a full recovery. Recurrent injury or graft failure can also occur, especially with early return to throwing.

What is recovery like?
Recovery after Tommy John surgery is a long, structured process. The elbow is initially protected in a brace, with early therapy focusing on restoring motion. Strengthening begins gradually, followed by a carefully monitored throwing program. Most athletes return to competitive throwing between 12–18 months after surgery. With dedication to rehab, many athletes achieve excellent pain relief and return to high-level sports, though patience is essential.