An ulnar collateral ligament (UCL) reconstruction surgery, also known as the Tommy John Surgery, is commonly indicated for baseball players and other athletes that participate in repetitive overhead movements with a torn UCL

This procedure was first performed on Tommy John, an MLB pitcher, in 1974.  This surgery involves using a tendon graft to reconstruct the torn UCL in the elbow.  The graft is typically obtained from the patient during surgery, and is usually from the ipsilateral (same side as the injury) forearm (palmaris longus tendon) or a hamstring tendon. Before placing the graft, the surgeon prepares tunnels in the bones on both sides of elbow joint at the sites of attachment of the native ligament.  The graft is threaded through these tunnels on the medial side (inside) of the elbow and secured in place with sutures or occasionally plastic screws.  An allograft (cadaver graft) is rarely used and is typically reserved for revision surgery. 

In certain circumstances, based on patient factors and MRI findings, a UCL repair can be performed.  A UCL repair does not use a graft, but instead uses a reinforced, strong suture-tape attached to the humerus and ulna using plastic screws.  The difference between the UCL repair and reconstruction is seen in the rehabilitation phase, and many patients with a repair can return to high-level throwing as early as 6 months after surgery.  After either surgery, the patient is placed in an elbow brace to protect the repair.  Intensive and dedicated physical therapy according to specified protocols is essential to obtain a good result and to allow return to full activity.