For athletes and weekend warriors alike elbow pain, which can often be injury to the ulnar collateral ligament, can be disabling. Tommy John Surgery is often performed to treat it. What is the ulnar collateral ligament? What actually is Tommy John Surgery? What is the Tommy John Surgery Success Rate? Let’s dig in.
What is Tommy John Surgery?
Tommy John surgery, also known as ulnar collateral ligament reconstruction is the “repair” of a damaged ulnar collateral ligament.
What is the Ulnar Collateral Ligament
The ulnar collateral ligament (UCL) is thick ligament on the inside of the elbow that connects the humerus, the upper arm bone, to the ulna, the lower arm bone. It provides critical support to the inside of the elbow joint. It consists of three portions: the anterior, the posterior and the intermediate. Injuries occur as a result of repeated stress and trauma. Overhead athletes such as baseball pitchers sustain the majority of the injuries but other overhead athletes can suffer a UCL injury which includes javelin, softball, tennis, volleyball, water polo, and gymnastic athletes (1). Young athletes are also impacted as he number of UCL injuries and surgical reconstruction in 15-19 year olds has increased 6-fold since the mid-1990s (2).
More Details About Tommy John Surgery
The surgical procedure to “repair” injury to the ulnar collateral ligament is called Tommy John Surgery. Tommy John surgery is invasive and starts with the removal of the damaged UCL. Holes are then drilled into the bones above and below the elbow joint. A tendon is then harvested either from the arm or leg which is then laced into the holes and sewn tight replacing the damaged UCL.
How Long Does It Take to Recover from a Tommy John Surgery?
Rehabilitation focuses on healing, elbow range of motion, and balanced strengthening. Recovery and rehabilitation is long as mean time to return to play for Major League Baseball players who underwent Tommy John Surgery is one year (3). Players greater than 30 years of age had significantly slower return to playtimes.
What Is the Tommy John Surgery Success Rate?
Success can be measured by different metrics which makes it difficult to accurately determine the Tommy John surgery success rate. Four different metrics were examined: return to play, performance, career longevity, and re-injuries.
Return to Play
Approximately 84% of players are able to return to play in the Major Baseball League after surgical repair (3).
Career Performance
A 2014 study followed 168 Major League Baseball pitchers for three years after Tommy John Surgery. While most players returned to play there is a statistically significant decline in pitching performance (4).
Career Longevity
Another study followed 313 baseball players who underwent Tommy John surgery. 83% of the players were able to return to the same or higher level of competition in less than 1 year. Unfortunately baseball career longevity was only 3.6 years in general and 2.9 years at the same or higher level of play (5).
Re-injuries
Unfortunately, re-injury is common. In a 2014 study that followed 147 pitchers that underwent surgical repair for UCL injuries, 57% of the players returned to the disabled list because of injuries to the throwing arm (6).
What is the Tommy John surgery success rate? If you are a major league baseball player who has the surgery you most likely will return to play with diminished performance, shorter career, and re-injuries.
Surgical Complications
Surgery risks and complications are important to understand. Complications from Tommy John Surgery include ulnar nerve injury, fracture of the lower arm bone, elbow stiffness, and inability to regain pre-injury throwing ability.
Nonsurgical Treatment Options
A fully torn ligament whose two ends are pulled apart (retracted) requires surgical repair. If however the ulnar collateral ligament is only partially torn there are non-surgical treatment options. PRP is an effective treatment option for partial UCL tears. In a recent study 34 athletes with documented partial-thickness UCL tears who failed conservative treatment underwent a single PRP injection and physical therapy (7). The average time to return to play was 12 weeks. Pain and functional scores improved after treatment. 88% had returned to the same level of play without any complaints at 70 weeks post-injection. Dines in a different study retrospectively analyzed 44 baseball players who underwent PRP injections for UCL partial-thickness tears. Results demonstrated PRP to be an effective nonsurgical option treatment (8).
In Conclusion…
Injury to the ulnar collateral ligament is common in overhead throwing athletes. Tommy John Surgery is the removal of the damaged tendon, drilling of holes into the upper and lower arm bones, and lacing the new tendon into place to act as new ligament. Rehabilitation is extensive and most players under 30 years of age return to play within 1 year. Tommy John surgery success rate is good for MLB players who wish to return to play. Unfortunately this success is associated with declining performance, shorter careers and re-injuries. PRP is an effective treatment option in partial-thickness tears of the UCL without the risks associated with surgery.
Dugas J, Chronister J, Cain EL, Andrews JR. Ulnar collateral ligament in the overhead athlete: a current review. Sports Med Arthrosc Rev. 2014;22(3):169-82.DOI: 10.1097/JSA.0000000000000033
Erickson BJ, Nwachukwu BU, Rosas S, et al. Trends in Medial Ulnar Collateral Ligament Reconstruction in the United States: A Retrospective Review of a Large Private-Payer Database From 2007 to 2011. Am J Sports Med. 2015;43(7):1770-4.DOI: 10.1177/0363546515580304
Jack RA, Burn MB, Sochacki KR, McCulloch PC, Lintner DM, Harris JD. Performance and Return to Sport After Tommy John Surgery Among Major League Baseball Position Players. Am J Sports Med. 2018;46(7):1720-6.DOI: 10.1177/0363546518762397
Keller RA, Steffes MJ, Zhuo D, Bey MJ, Moutzouros V. The effects of medial ulnar collateral ligament reconstruction on Major League pitching performance. J Shoulder Elbow Surg. 2014;23(11):1591-8.DOI: 10.1016/j.jse.2014.06.033
Osbahr DC, Cain EL, Raines BT, Fortenbaugh D, Dugas JR, Andrews JR. Long-term Outcomes After Ulnar Collateral Ligament Reconstruction in Competitive Baseball Players: Minimum 10-Year Follow-up. Am J Sports Med. 2014;42(6):1333-42. DOI: 10.1177/0363546514528870
Makhni EC, Lee RW, Morrow ZS, Gualtieri AP, Gorroochurn P, Ahmad CS. Performance, Return to Competition, and Reinjury After Tommy John Surgery in Major League Baseball Pitchers: A Review of 147 Cases. Am J Sports Med. 2014;42(6):1323-32. DOI: 10.1177/0363546514528864
Podesta L, Crow SA, Volkmer D, Bert T, Yocum LA. Treatment of partial ulnar collateral ligament tears in the elbow with platelet-rich plasma. Am J Sports Med. 2013;41(7):1689-94. DOI: 10.1177/0363546513487979
Dines JS, Williams PN, ElAttrache N, et al. Platelet-Rich Plasma Can Be Used to Successfully Treat Elbow Ulnar Collateral Ligament Insufficiency in High-Level Throwers. Am J Orthop. 2016;45(5):296-300.
Learn more about your elbow condition and how Interventional Orthopedics can prevent the need for surgery by reading Orthopedics 2.0.
