Ulnar collateral ligament (UCL) reconstruction

Ulnar collateral ligament (UCL) reconstruction

UCL (ulnar collateral ligament) reconstruction surgery is a procedure performed to treat a tear in the UCL in the elbow. The UCL is one part of a complex of ligaments and tendons that attaches the lower and upper arm bones to the elbow. UCL tears tend to worsen gradually over time, cause your arm to weaken and eventually prevent you from being able to use your arm to exert significant force.

Baseball pitchers are highly susceptible to a UCL tear in the pitching arm. The repetitive throwing motion combined with the amount of force behind it (pitching balls at 70 to 100 miles per hour) puts a high degree of strain on the elbow joint. Inflammation, cartilage injuries, bone spurs and eventually a UCL tear can result from this repetitive force on the elbow. Prior to the development of UCL reconstruction surgery, an UCL tear was a career-ending injury for athletes. Pitchers and other athletes who put tremendous strain on their elbows benefit the most from UCL reconstruction, because it allows them to return to their previous level of athletics.

Non-throwing athletes can acquire an UCL tear, too, but usually don't require surgery to treat the torn ligament. 


UCL reconstruction is often referred to as “Tommy John surgery (TJS),” in reference to the famous baseball player who received the surgery 40 years ago. The procedure involves taking a spare tendon from your forearm and using it to recreate the UCL in the elbow. The surgeon might instead opt to acquire the replacement tendon from a donor.

Surgery begins with your orthopaedic surgeon making an incision over the elbow joint. The muscles are split, and the nerves are moved away from the area to avoid injury. The remaining portion of the UCL is reattached to the lower arm bone (the ulna). The tendon graft is threaded through holes created in the ulna and the upper arm bone (humerus), then sutured to stabilize the joint. Some surgeons will create three holes in the bones, while others prefer to drill one hole in the humerus.

Thanks to major advances in surgical techniques and tools, UCL reconstruction surgery can be performed in as little as 60 minutes, in contrast to the original four-hour procedure of four decades ago. After surgery, you can expect recovery to take as long as a year. Once your doctor confirms that the UCL has been properly reattached and is completely healed, you will be able to return to your normal level of athletic activity.

Animated video: Ulnar collateral ligament reconstruction (Tommy John surgery)

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