What is UCL Reconstruction?
Commonly called Tommy John surgery, this procedure involves reconstructing a damaged ligament on the inside of the elbow called the ulnar or medial collateral ligament with a tendon graft obtained from your own body or a donor.
UCL Anatomy
The ulnar collateral ligament (UCL), also called medial collateral ligament, is located on the inside of the elbow and connects the ulna bone to the humerus bone. It is one of the main stabilizing ligaments in the elbow, especially with overhead activities such as throwing and pitching.
UCL Injury
When this ligament is injured, it can end a professional athlete’s career unless surgery is performed. The common symptoms associated with a UCL injury are as follows:
- Pain on the inner side of the elbow
- Unstable elbow joint
- Numbness in the little finger or ring finger
- Decreased performance in activities such as throwing baseballs or other objects
UCL reconstruction surgery involves replacing a torn ulnar collateral ligament with a tendon from elsewhere in the body. It is also referred to as Tommy John Surgery.
Treatment of UCL Injuries
Your physician will recommend conservative treatment options to treat the symptoms associated with UCL injury unless you are a professional or collegiate athlete. In these cases, if the patient wants to continue in their sport, surgical reconstruction is performed.
Conservative treatment options that are commonly recommended for non-athletes include the following:
- Activity restrictions
- Orthotics
- Ice compression
- Medications
- Physical therapy
- Pulsed ultrasound to increase blood flow to the injured ligament and promote healing
- Professional instruction
UCL Reconstruction
If conservative treatment options fail to resolve the condition and symptoms persist for 6-12 months, your surgeon may recommend ulnar collateral ligament reconstruction surgery. UCL reconstruction surgery repairs the UCL by reconstructing it with a tendon from the patient’s own body (autograft) or from a cadaver (allograft). The most frequently used tissue is the palmaris longus tendon in the forearm. The basic steps for UCL reconstruction surgery include the following:
- The surgery is performed in an operating room under regional or general anesthesia
- Your surgeon will make an incision over the medial epicondyle area
- Care is taken to move muscles, tendons, and nerves out of the way
- The donor's tendon is harvested from either the forearm or below the knee
- Your surgeon drills holes into the ulna and humerus bones
- The donor's tendon is then inserted through the drilled holes in a figure 8 pattern
- The tendon is attached to the bone surfaces with special sutures
- The incision is closed and covered with sterile dressings
- Finally, a splint is applied with the elbow flexed at 90 degrees.
Postoperative care for UCL Reconstruction
After surgery, your surgeon will give you guidelines to follow, depending on the type of repair performed and the surgeon’s preference. Common postoperative guidelines include:
- Elevate your arm above heart level to reduce swelling
- Wear an immobilizing splint or cast for 1-3 weeks
- Apply ice packs to the surgical area to reduce swelling
- Keep the surgical incision clean and dry. Cover the area with plastic wrap when bathing or showering
- Physical therapy will be ordered for strengthening and stretching exercises after the removal of the splint or cast
- Professional athletes can expect a strenuous strengthening and range of motion rehabilitation program for 6-12 months before returning to their sport
- Eating a healthy diet and not smoking will promote healing
Risks and Complications of UCL Reconstruction
As with any major surgery, there are potential risks involved.
The majority of patients suffer from no complications following UCL Reconstruction surgery, however, complications can occur following elbow surgery and include:
- Infection
- Limited range of motion
- Nerve damage causing numbness, tingling, burning or loss of feeling in the hand and forearm area
- Cubital Tunnel Syndrome
- Elbow instability
Why Choose Dr. Acevedo for Tommy John Surgery (UCL Reconstruction)
Patients choose Daniel C. Acevedo for UCL reconstruction because of his specialized expertise in treating throwing-related elbow injuries and helping athletes safely return to performance.
Reasons to choose Dr. Acevedo include:
- Fellowship-trained specialist focused exclusively on shoulder and elbow conditions
- Extensive experience treating UCL injuries in throwing and overhead athletes
- Expertise in advanced ligament reconstruction techniques (Tommy John surgery)
- Deep understanding of throwing mechanics and injury patterns in athletes
- Comprehensive evaluation to determine surgical vs. non-surgical treatment
- Personalized treatment plans based on sport, position, and performance goals
- Focus on restoring elbow stability, strength, and throwing function
- Use of modern graft and fixation techniques for durable reconstruction
- Structured rehabilitation and return-to-throwing programs
- Goal-oriented care to help athletes safely return to competitive play
Tommy John Surgery (UCL Reconstruction) FAQs
What causes a UCL tear?
UCL tears are most often caused by repetitive stress to the medial (inner) elbow during overhead throwing. Common contributors include:
- Baseball pitching
- Javelin or softball pitching
- Repetitive overhead or forceful arm motions
- Inadequate rest or poor mechanics
How is a UCL tear diagnosed?
Diagnosis begins with a physical exam and evaluation of symptoms. Imaging tests, such as MRI or ultrasound, are commonly used to confirm the extent of the ligament injury.
Will I need physical therapy after UCL reconstruction?
Yes. Physical therapy is essential and focuses on restoring range of motion, strengthening arm and shoulder muscles, and gradually progressing to sport‑specific throwing programs.
What are the risks of Tommy John surgery?
Risks may include infection, nerve irritation, stiffness, graft failure, or incomplete return to previous performance level. Your surgeon will discuss these risks in detail and how they are minimized.
Can I return to competitive sports after UCL reconstruction?
Many athletes successfully return to competitive sports following Tommy John surgery when guided by a structured rehabilitation program. Return depends on healing, strength restoration, mechanics correction, and adherence to rehabilitation protocols.
