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Tommy John Surgery

Surgery to Reconstruct the Medial Collateral Ligament of the Elbow

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Updated June 25, 2014

throw overuse

Baseball players may require Tommy John surgery for MCL tears of the elbow.

Photo © Piccillo Photography

Tommy John surgery is a surgical  procedure to reconstruct ligaments that support the inner (medial) side of the elbow joint.  This surgery is most often associated with baseball players, specifically pitchers, who place tremendous stress on the medial collateral ligaments with the throwing motion. 

Tommy John, the Baseball Player

Tommy John was a pitcher for the Los Angeles Dodgers baseball team. In 1974 he was unable to pitch because of an injury to his elbow. John had injured the medial collateral ligament on his pitching arm.  Until that time, this particular injury almost always ended the career of baseball pitchers.

Medial Collateral Ligament Injuries

The specific ligament injured is the medial collateral ligament (MCL) on the inside of the elbow joint. Often, physicians refer to this ligament as the ulnar collateral ligament (UCL); therefore, when talking about the elbow, saying the medial collateral ligament or the ulnar collateral ligament mean the same thing. 

Patients with injury to the medial collateral ligament have pain on the inside of the elbow and may have a sensation of instability of the joint. Other causes of pain on the inside of the elbow include tendonitis, and ulnar nerve conditions.  Injuries typically are the result of overuse, but can also be an acute injury. 

Tommy John Surgery

Tommy John surgery is a surgical procedure to reconstruct the medial collateral ligament using a tendon from the forearm. The tendon is used to reconstruct the damaged ligament and improve the stability of the elbow joint.  The tendon used to reconstruct the MCL is typically the palmaris longus tendon, although other tendons can be used as well, as some people don't have a palmaris longus tendon.

Tommy John surgery was developed by Dr. Frank Jobe in Los Angeles. Today, Tommy John surgery can be used to extend the career in many baseball pitchers; the success rate following surgery is about 85%. Rehabilitation following surgery often sidelines the athlete for 12-18 months.

Sources:

Jobe FW, et al. "Medial Elbow Problems in the Overhead-Throwing Athlete" J Am Acad Orthop Surg March/April 2001; 9:99-113.

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