Tommy John Surgery (UCL Reconstruction)

If you’ve injured your ulnar collateral ligament (UCL) and are experiencing pain, instability, or a loss of function, your provider may recommend Tommy John surgery.

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Your ulnar collateral ligament (UCL) is a band of fibrous connective tissue on the inner side of your elbow. A UCL injury is often the result of repetitive, forceful overhead movements and can range from minor fraying to partial or complete tears, or even detachment from the bone. Depending on the location of your tear and the quality of your ligament tissue, your provider may recommend Tommy John surgery.

Tommy John surgery, or UCL reconstruction, is a procedure used to restore elbow stability and function by replacing the damaged ligament with a tendon graft, typically taken from your forearm or hamstring.

At University of Iowa Health Care, our orthopedic and sports medicine specialists have extensive experience and specialized expertise in the treatment of UCL injuries, including Tommy John surgery, to help you regain strength and return to the activities you love.

Why is it called Tommy John surgery?

The surgery is nicknamed “Tommy John surgery” after major league pitcher Tommy John, who was the first baseball player to have the procedure in 1974. When the surgery was successful and he was able to return to the sport in 1975, people began referring to UCL reconstruction as Tommy John surgery.

Our approach to Tommy John surgery

UI Health Care orthopedic specialists have decades of experience diagnosing and treating UCL injuries. Using advanced imaging and the latest surgical techniques, they develop personalized treatment plans based on your specific needs and recovery goals.

We are also home to a dedicated orthopedics hospital that is designed to deliver comprehensive care in one convenient location. With clinic visits, advanced imaging, surgical procedures, and physical therapy all housed under one roof, you can expect seamless, coordinated care throughout your treatment.

What is Tommy John surgery?

Tommy John surgery is a long-established surgical option for UCL injuries and is commonly recommended when the UCL in your elbow is torn in the middle or is too stretched, frayed, or unhealthy to be repaired. It involves:

Repairing the damaged ligament
Augmenting the ligament with a tendon graft, typically taken from your forearm or hamstring
Drilling small holes in your ulna (forearm bone) and humerus (upper arm bone)
Threading the tendon through these holes and anchoring it with sutures or screws

Following your reconstruction surgery, your surgeon will recommend a structured physical therapy and rehabilitation program to strengthen the new tissue and improve throwing mechanics. Recovery from reconstruction typically takes at least nine to 12 months.

UCL repair vs. UCL reconstruction

The choice between UCL repair and UCL reconstruction depends on the location of your tear and the quality of your ligament tissue.

UCL repair is typically used for more acute injuries where the ligament has been pulled from the bone attachment on one of the ends but otherwise remains healthy. During repair, your UCL is surgically reattached and reinforced with an internal brace—a strong suture tape that adds stability during healing. UCL repair is a good option for younger athletes because it is less invasive and has a shorter recovery time (typically six to nine months).

UCL reconstruction is used when the ligament is torn in the middle or too damaged to repair. Surgeons often plan for a repair but are prepared to switch to reconstruction during surgery, if needed.

What to expect from your Tommy John surgery

Tommy John surgery is done on an outpatient basis, so there is no need for an overnight hospital stay. A typical surgery lasts between 90 minutes to two hours.

Before the surgery

Follow your surgeon's instructions about taking certain medications.
The surgeon will order no food or liquid by mouth (usually 12 hours) before the procedure.

During the procedure

An anesthesiologist will administer general anesthesia to put you to sleep. You will feel no pain during the procedure.
The surgeon will make an incision along the inner elbow and examine the UCL to determine the type of tearing and damage.
The damaged UCL is repaired as much as possible.
If a reconstruction is needed, then the surgeon will remove a tendon graft from another part of your body, often the forearm or hamstring
The surgeon will drill holes in the ulna (a forearm bone) and the humerus (upper arm bone) and graft the new tendon in position directly over the old UCL.
The surgeon will secure the ends of the graft in one of two configurations, the docking technique or the figure-8 technique, which are slightly different ways of threading the graft and the sutures that secure it through the holes in the bones.
The surgeon will close the incisions and bandage the area.

After the procedure

Your elbow will be supported in a hinged elbow brace that allows motion between a 60-degree to 90-degree angle for the first few weeks.
About two weeks after surgery, you will begin physical therapy, and the therapist assists with gradually allowing the brace to have more range of motion.
You will begin limited exercise and physical therapy to strengthen your fingers, wrist, upper arm and shoulder and prevent muscle atrophy.
Your rehabilitation will progress as your strength improves.
If you are involved in a throwing sport, you may receive special instruction on better throwing mechanics.
You may be allowed to return to throwing in competition after seven to nine months; pitchers generally can return to full participation between nine and 12 months after surgery.

Who gets Tommy John surgery?

Tommy John surgery is most commonly performed on athletes—especially baseball pitchers and other overhead-throwing athletes—who make up the majority of all patients. UCL injuries can also occur in other sports such as wrestling, football and others. If you're an athlete with a torn UCL and plan to continue competing long-term, your provider may recommend surgical reconstruction to restore stability and performance.

For non-athletes with UCL injuries, surgery is rarely necessary. Most people benefit from conservative treatments such as rest, physical therapy, and bracing, which can effectively relieve symptoms and support healing.

Our orthopedic specialists will evaluate each patient’s case and needs to determine the best course of treatment that leads to the best possible outcome. This includes a physical exam and may involve imaging tests such as X-rays, ultrasounds, or MRIs to assess the extent of the injury. Based on your activity level, goals, and imaging results, we’ll tailor a care plan that leads to the best possible outcome.