Ulnar collateral ligament reconstruction
| Ulnar collateral ligament reconstruction | |
|---|---|
| Intervention | |
| Synonyms | UCL reconstruction, Tommy John surgery (TJS) |
| ICD-9-CM | 81.85 |
Ulnar collateral ligament reconstruction, also known as Tommy John surgery (TJS), is a surgical graft procedure in which the ulnar collateral ligament in the medial elbow is replaced with either a tendon from elsewhere from the patient's own body, or the use of a tendon from the donated tissue of a cadaver. The procedure is common among collegiate and professional athletes in several sports, most notably baseball.
The procedure was first performed in 1974 by orthopedic surgeon Frank Jobe, then a Los Angeles Dodgers team physician who served as a special advisor to the team until his death in 2014. It is named after the first baseball player to undergo the surgery, major league pitcher Tommy John, whose record of 288 career victories ranks seventh all time among left-handed pitchers. The initial operation, John's successful post-surgery career, and the relationship between the two men is the subject of a 2013 ESPN 30 for 30 documentary.
At the time of Tommy John's operation, Dr. Jobe put the chances for success of the operation at 1 in 100. In 2009, prospects of a complete recovery had risen to 85–92 percent.
Following his 1974 surgery, John missed the entire 1975 season rehabilitating his arm before returning for the 1976 season. Before his surgery, John had won 124 games. He won 164 games after surgery, retiring in 1989 at age 46.
For baseball players, full rehabilitation takes about one year for pitchers and about six months for position players. Players typically begin throwing about 16 weeks after surgery. While eighty percent of players return to pitching at the same level as before the surgery, for those Major League pitchers who receive the surgery twice, thirty five percent do not return to pitch in the majors at all.
The ulnar collateral ligament (UCL) can become stretched, frayed, or torn through the repetitive stress of the throwing motion. The risk of injury to the throwing athlete's UCL is thought to be extremely high as the amount of stress through this structure approaches its ultimate tensile strength during a hard throw.
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