What is elbow UCL reconstruction/Tommy John surgery?

Tommy John surgery, also known as ulnar collateral ligament reconstruction, involves the surgical reconstruction of an unstable or ruptured UCL. Your UCL is that brutal band of tissue inside your elbow—the joint where your arm bones meet. Through Tommy John surgery, your surgeon will strengthen your joint by grafting a healthy tendon from another part of your body. If, for some reason, your tendons will not work, your surgeon may also use one from a donor. The tendon is termed a graft, whether from you or a donor. Your surgeon attaches the graft to your ulna and humerus, thus making them function as a new UCL that stabilizes your elbow, reduces the pain, and restores your range of motion.

Tommy John surgery is another name for the reconstruction of the UCL for one of the MLB's primary baseball players, who had his UCL ruptured. He received the UCL reconstruction in 1974. Though he had to forego a season, Tommy John returned to professional baseball after surgery.

Who might be considered for Tommy John Surgery?

The UCL is much more likely to suffer overuse injuries with the tears resulting from too much stress than with the single traumatic tears requiring Tommy John's surgery. This overuse injury occurs unexpectedly in baseball pitchers and all other athletes who experience a good deal of elbow bending. Your surgeon may recommend Tommy John surgery if your lifestyle or jobs require great stress in your elbow or if nonsurgical treatments can't help ease your pain.

What happens before Tommy John surgery?

Your doctor determines the severity of your UCL injury.

This diagnosis may involve imaging tests, such as an X-ray, a computed tomography (CT) scan, and magnetic resonance imaging (MRI), to determine whether there is a fracture or torn ligament.

A valgus stress test is administered to check whether the joint feels loose and pain occurs.

They'll talk to you about how highly you participate in sports and what date would be good for you to return to sports before determining whether surgery versus nonsurgical treatment is necessary.

Before recommending Tommy John surgery, your orthopedic surgeon will push nonsurgical treatments on you, starting with:

Rest.
Ice.
Use of NSAIDs.
Non-throwing physical therapy.

How do I prepare for this surgery?

Your surgeon will tell you what, if anything, you need to do to prepare for Tommy John surgery. In general, for the surgical procedure, you should expect the following:

A physical exam to confirm you are healthy enough for surgery
Blood tests
An electrocardiogram to ensure that you have a healthy heart
A dental examination to minimize your risk of infection from surgery.
Ask your provider and surgeon what you need to discuss, such as any medications or OTC supplements, as some must be stopped before surgery.

A surgeon will alert you to when you should cease eating and drinking the day before surgery. Virtually all patients will require a 12-hour fast without food or beverages before their UCL reconstruction.

What is done in the Elbow UCL procedure?

Your surgical team will help you get as comfortable on the table as possible. You will lie on your back with your arm supported. Your anaesthesiologist will administer general anaesthesia; it generally is said to put a patient to sleep for the entirety of the surgery, and he feels no pain.

Your surgeon may first use elbow arthroscopy to look inside your elbow. No one needs this. However, should they find other injuries to your elbow joint, they may fix these simultaneously as your UCL reconstruction.

Your surgeon will remove a piece of tendon from somewhere else in your body as part of this procedure. They take the tendon most often from the palmaris longus tendon on the bottom of your forearm but sometimes from the backside of your knee behind your hamstring.

Your surgeon will then cut on the inside of your elbow and remove all of the damaged tissue. Typically, this is followed by drilling two in your ulna and three in your humerus in a Y configuration. The ligament harvest creates tunnels through which your surgeon passes the harvested ligament. Your surgeon then stitches the ligament to itself in order to make a loop, positioning the bones together. Some other modifications use fewer holes and/or screws to secure the tendon graft.

If your injury damaged your ulnar nerve, your surgeon may relocate this outside the cubital tunnel during your Tommy John surgery. This will allow you to move your elbow without irritating the nerve.

After your surgeon tests the strength of the graft, he or she will close your muscles and skin with sutures and dress you with a clean dressing. Your arm will be put in a stiff splint that prevents movement at the elbow, called immobilization.

What happens after the elbow UCL reconstruction?

You will be able to switch to a hinged brace after approximately one to two weeks when your elbow has healed. It allows you to do some exercises as it hinges at your elbow. However, when you are not exercising, you close the hinge so your body gets rest and heals.

Following your surgeon's evaluation approximately 12 to 16 weeks after the surgery, you can start a supervised rehabilitation program, which will include some (modest!) throwing. Your strength will gradually return, and you'll be able to throw more. Most people are back playing in around 12 to 18 months.

What are the benefits of this surgery?

There are several advantages to Tommy John surgery:

Most patients who undergo this procedure return to play after rehabilitation.
You might achieve better endurance for throwing. However, you should not go for Tommy John's surgery to just improve your endurance.
You will unlikely need revision surgery.

What are the risks and complications of Tommy John surgery?

Like other surgeries, the UCL reconstruction is susceptible to the risk of infection and other complications arising from anesthesia. Postoperative complications such as nerve or blood vessel injury may occur. Injury to these tissues can cause permanent or transient numbness and weakness.

Another complication could be the stretching or even rupture of the graft. In this situation, another graft can be used to perform a reconstruction again. Complications can also arise from the graft harvesting site, and they are rare but can be resolved through medication.

The elbow injury may also irritate the ulnar nerve. The UCL is on the medial aspect of the elbow, where the ulnar nerve bends around the elbow joint. To further minimize irritation to the ulnar nerve, it could have to be set in front of the elbow joint.

How long will it take to recover?

Recovery from Tommy John surgery is long and tough. You will at least need to rest, recover, strengthen, and retrain for nine months, probably more than that, before returning to sports. You wear a hinged brace for four to six weeks to gradually advance your range of motion. Your physical therapists and sports medicine team monitor you in rehabilitation, and then notify you when you're ready to get back into play.

When should I call my doctor?

Call your surgeon or your doctor immediately if you have any of these symptoms:
Chest pain,
Shortness of breath or having trouble breathing
Fever over 102 degrees Fahrenheit or 39 degrees Celsius
Bleeding Signs of infection at your surgical site, which may include leaking, swelling, a change in color, odor, or warmth
Pain in your elbow, arm, or hand that is new or worse.
It is a severe pain that cannot be alleviated with the use of pain relief drugs.

Why Tender Palm Super-Speciality Hospital for Elbow UCL Reconstruction/Tommy John Surgery?

Tender Palm Hospital, owned by doctors, is renowned for attracting the most skilled professionals in the country. With the finest Orthopedic surgeons, specialized in Elbow UCL Reconstruction/Tommy John Surgery. Tender Palm stands out as the premier orthopedic hospital in Lucknow, India. Boasting cutting-edge infrastructure and advanced technology, Tender Palm ensures top-notch medical care for its patients.