Ulnar Collateral Ligament Reconstruction

(Tommy John Surgery)

By Joshua Wright and Emily

Herbert with insight from Dr.
Christopher Mazoue
Preoperative
Ulnar Collateral Ligament - triangular band at medial aspect of elbow uniting distal humerus to proximal
ulna

Etiology: UCL can become stretched or torn through repetitive stress of throwing motion

- Most patients are softball or baseball players - throwing motion twists the elbow
- Biggest determinant = amount of pitches thrown, previously thought to be type of pitch
- “Little League Elbow” in younger athletes

Symptoms:

- Pain or sense of looseness on inside of elbow

- Tingling/numbness felt in ring finger
- Instability in throwing motion
- MRI or X-Ray commonly used to diagnose
Intraoperative- the procedure
-Usually it is an outpatient procedure, so you can go home the same day

1. A graft is harvested, usually from the palmaris longus tendon or the hamstring
2. A 3-4 inch incision is made on the outside of the elbow, muscles and tissues
are moved out of the way so the surgeon can assess the amount of damage
3. Damaged tissue is removed
4. Holes are drilled into the two bones that the

UCL originally connected (humerus and ulna)

1. The graft is threaded through the holes

and secured with sutures or screws

Intraoperative- Risks
- Like every operation there is a small risk for infection, antibiotics might be
given before the operation to reduce infection risk
- There can be issues with anesthesia if it reacts with other drugs the patient is
taking, the patient can struggle with the actual anesthesia, or there can be
lung complications
- Complications can occur in 5-20% of patients depending on the technique
used, most common complication is damage

to the ulnar nerve

- For staff risks include exposure to infection,

chance of trip or fall, chance of needle stick injury

Intraoperative
-Roles of Surgical Team: Surgeon- performs the actual incisions and make critical
decisions, Anesthesiologist- administering anesthesia and monitoring the patient
during surgery, surgical technicians- the circulating technician and the scrub
technician (provide surgeon with instruments), Registered Nurses- same jobs as
the technicians, sometimes first assist surgeons

-Equipment used: retractors, scalpel, sutures, metallic

button for anchor, forceps, pin, reamer, drill pin,

scissors, interference screw, wire

Postoperative
- Full rehabilitation takes around 1 year
- Around 85% of patients can return to previous level of competition

Phase 1:

- Splint 7-10 days

- Elbow elevation
- Gentle wrist exercises
- Strengthen arm and shoulder

Phase 2:

- About 6 weeks after surgery, patient can begin elbow strengthening exercises

Phase 3:

- 4 or 5 months after surgery, patient can begin throwing again

- 9 months after surgery patient can return to competition if there is no longer pain
References
Ulnar Collateral Ligament Reconstruction (Tommy John Surgery). (n.d.). Retrieved November 14, 2017, from
http://www.houstonmethodist.org/orthopedics/where-does-it-hurt/elbow/ulnar-collateral-ligament-reconstruction/

Tommy John Surgery (Ulnar Collateral Ligament Reconstruction). (n.d.). Retrieved November 14, 2017, from
https://www.hopkinsmedicine.org/healthlibrary/test_procedures/orthopaedic/Tommy_John_Surgery_22,TommyJohnSurgery

Ulnar Collateral Ligament Reconstruction (Tommy John Surgery). (n.d.). Retrieved November 14, 2017, from
http://www.houstonmethodist.org/orthopedics/where-does-it-hurt/elbow/ulnar-collateral-ligament-reconstruction/

Roles of Operating Room Personnel. (n.d.). Retrieved November 14, 2017, from http://work.chron.com/roles-operating-room-
personnel-17867.html