What is Tommy John Surgery?

When Los Angeles Dodgers’ baseball pitcher Tommy John suffered a career-ending elbow injury in 1974, he insisted that the surgeon find a way to repair it and get him back on the pitcher’s mound.

His surgeon, Dr. Frank Jobe, harvested a tendon from John’s forearm and attached it on the inside of Tommy John’s elbow to create a new ligament. The pioneering surgery was successful; Tommy John compiled an impressive record and played in the major leagues for 13 more seasons.

Considered miraculous at the time, the surgery has become a mainstay for throwing athletes, especially in baseball and football who, like Tommy John, have suffered a tear in the ulnar collateral ligament (UCL), located on the inside of the elbow.

MUSC Health orthopedist Dr. Josef Eichinger is one of a small community of surgeons who performs the specialized procedure on high school, collegiate and pro athletes, as well as non-athletes who have injured their elbow or have a degenerative elbow condition.

“Your UCL helps stabilize your elbow joint,” Dr. Eichinger says. “A torn UCL can cause extreme pain and weakness and reduce joint stability. Over the years, Tommy John surgery has become the tried-and-true procedure for reconstructing a torn UCL. Only a few surgeons do this surgery, and it must be done really, really well to restore the anatomy as perfectly as we can.”

UCL reconstruction involves taking a ligament from elsewhere in the body, typically a small tendon from the forearm, called the palmaris longus which is used to create a new UCL to replace or augment the torn UCL. If the patient’s palmaris longus tendon is too small or absent, Dr. Eichinger will use the other arm or the hamstring tendon on the inside of the leg, called the gracilis, to implant inside the elbow. Depending on the patient’s age and activity level, the surgeon may use tissue from another donor (allograft) if needed, he says.

The procedure, which is outpatient surgery, takes just under two hours. Patients undergo a standard rehabilitation program. Recovery time varies, and post-surgery problems are very rare. 

“Recovery time depends on who is getting the surgery and why,” Dr. Eichinger says. “Non-athletes typically return to unrestricted activity in three to four months. For athletes, particularly throwing athletes such as baseball pitchers, javelin throwers and quarterbacks, a standard throwing and strengthening protocol is followed and spells when and how to resume throwing. This recovery process is longer and requires patience and physical therapy. Fortunately, we have a multidisciplinary team including trained therapists who work with throwing athletes and follow specialized training and detailed protocols throughout their recovery.”

Although athletes can have the surgery again if they injure their UCL, Dr. Eichinger says that is rare, and he’s never had to perform one fortunately and speaks to the reliability of Tommy John surgery. He chooses his patients carefully and, for many younger athletes with open growth plates, will explore alternative procedures such as platelet rich plasma injections, physical therapy and UCL repairs instead of reconstruction.