What is Tommy John Surgery?

What is Tommy John Surgery?

Tommy John surgery, also known as ulnar collateral ligament (UCL) reconstruction, is used to repair a tear in the UCL. The UCL is found on the inner side of the elbow and helps keep the elbow joint stable. Anyone can tear their UCL with repetitive stress to the elbow joint, but athletes that perform throwing motions — like baseball, football, and softball players — are at the highest risk. 

A Tommy John surgery aims to reduce pain and restore range of motion so the patient can regain the ability to throw and otherwise successfully use their elbow. The first person to undergo a UCL reconstruction was baseball pitcher Tommy John in 1974, leading to the procedure’s nickname.

How is Tommy John Surgery Performed?


Tommy John surgery involves the replacement of the ulnar collateral ligament (UCL) with a tendon harvested from somewhere else in the patient’s body. This tendon can come from several body parts, including the wrist, forearm, knee, hamstring, foot, or toe. 

The surgery is usually an outpatient procedure and takes anywhere from an hour to 90 minutes. Your doctor will perform the surgery while you are under general anesthesia. They will make two incisions, one to harvest the replacement tendon and one to access the UCL. After repairing and cleaning out your elbow joint, then connecting the replacement tendon, your doctor will close the incision and secure your elbow in a brace.

Risks to Consider


Like any surgical procedure, Tommy John surgery carries potential risks, including infection, blood clots, bleeding, general anesthesia complications, and breathing problems. Tommy John surgery also has the risk of complications unique to this procedure; the ulnar nerve at the site of the procedure can be irritated by the surgery, and stretching or rupture of the new tendon can also occur, requiring additional surgery. Complications are rare, but you can reduce your risk of issues following the surgery by following your doctor’s directions and calling them immediately if you experience increased pain, bleeding, or fever following the procedure.

Preparing for Surgery


Before your surgery, be sure to follow all of your doctor’s instructions and ask any questions you may have about the procedure.

What to Expect After a Tommy John Surgery

After the Surgery

Following the surgery, you will be groggy from the anesthesia and unable to drive home, so it’s important to arrange transportation from the doctor’s office. Your range of motion may be limited immediately following Tommy John surgery, so preparing your home for recovery is important. Pre-making meals and keeping clothing without buttons or zippers on hand can make your recovery easier.

Full recovery after Tommy John surgery usually takes about a year but can take up to two years in some cases. Immediately following surgery, you may experience pain and can take over-the-counter pain relievers to manage it. Your doctor will prescribe a physical therapy program to aid your recovery and should stay in close contact with you to monitor your progress. Be sure to let them know if the pain is preventing you from performing assigned exercises.

Many rehabilitation programs follow a three-phase process:

  • Phase I - Immediately after surgery, your doctor will place your elbow in a splint to immobilize the elbow joint. The splint will remain for seven to 10 days, during which you will be instructed to perform a gentle range of motion and strengthening exercises for the wrist, hand, and shoulder. You will wear a flexible brace on the elbow following the splint.
  • Phase II - The second phase of rehabilitation begins around six weeks after surgery, and is when most patients will begin elbow-strengthening exercises. You should be able to fully extend the elbow during this phase. You may remove the elbow brace around this time.
  • Phase III - In the final rehabilitation phase, athletes, such as baseball pitchers, can gradually begin throwing again in stages. You will begin new exercises focused on flexibility and more intense strengthening during this phase, which lasts until the end of your recovery.
Get Care

Tommy John Surgery at NewYork-Presbyterian

At NewYork-Presbyterian, our Columbia orthopedic experts can speak with you about your options if you’re experiencing symptoms consistent with a torn UCL. Our orthopedic surgeons will discuss the risks and benefits of Tommy John surgery and walk you through the process and recovery so you feel empowered throughout treatment.