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The Benefits and Risks of Tommy John Surgery

A professional baseball pitcher throws tens of thousands of full-force pitches over the course of their career. These athletes depend on their ulnar collateral ligament (UCL), a tiny band of tissue located in the elbow, in order to repeatedly and consistently pitch at speeds of 90 mph or more. Over time however, the force generated by their throw and the repetitive stress of pitching can cause a UCL to tear. A UCL tear inhibits a pitcher’s ability to grip a ball, perform overhead motions, and throw with the speed necessary to compete.

Fortunately, UCL tears are no longer the career ending injuries they once were. Ulnar collateral ligament reconstruction—better known as Tommy John surgery after the Dodgers pitcher who first received the surgery in 1974—can effectively treat a tear. During the surgery, the damaged UCL is completely replaced with a healthy tendon, providing effective relief of the patient’s symptoms. However, Tommy John surgery is not always necessary for UCL injuries, and like all surgical procedures, there are risks of complications. It’s important to know the benefits and risks of Tommy John surgery in order to guide your discussion with an orthopaedic specialist.

What Leads to Tommy John surgery?

In order to understand the benefits of Tommy John surgery, it’s important to first understand the symptoms that the surgery is intended to treat.

Anatomy of the Elbow

The ulnar collateral ligament connects the humerus (upper arm bone) to the ulna (forearm bone opposite of the thumb). The UCL stabilizes the inside of the elbow against valgus stress, or stress that results from the hand moving away from the body. While the UCL can handle a reasonable amount of stress, force that exceeds its’ tensile strength can stretch or tear the ligament. Moreover, repetitive use of the elbow can cause microscopic, undetected tears to develop. These tears gradually increase in size, weakening the ligament and consequently making it more susceptible to further injury.

UCL tears are common among athletes who make frequent overhand motions, including javelin throwers as well as football, tennis, and hockey players. Professional baseball pitchers – by far – face the highest risk of a UCL tear. In fact, approximately 1 in 4 injuries sustained by professional pitchers is related to the elbow. This is due in part to the amount of valgus stress generated by the average pitch. During the acceleration phase of an overhead throw, the forearm lags behind the upper arm. This puts stress on the elbow that can exceed 60 newton meters (N m), which far exceeds the 34 N m the ligament can handle. In short, every full-force pitch that a pitcher throws poses a serious risk of a tear.

When a tear develops, an individual may experience:

  • Pain on the inside of the elbow
  • Pain when using the arm in an overhead position
  • Swelling along the inside of the elbow
  • Decreased hand grip and forearm strength
  • Instability in the elbow

While muscles around the elbow can be strengthened in order to compensate for this instability, athletes often need to do more than just manage the symptoms of a tear—they need to treat the condition at its source. An orthopaedic specialist may recommend Tommy John surgery in order to restore normal elbow function and help them return to their sport.

How the Surgery is Performed

Tommy John surgery is performed by using a grafted tendon to replace the damaged ligament. The surgery begins with an incision on the inside of the elbow joint. Then a healthy tendon is harvested from another area of the patient’s body or a donated tendon is prepared. Next, the damaged ligament is removed and replaced. Finally, the incision is stitched up and the elbow is placed in a large bandage. A typical Tommy John procedure takes 90 minutes. Because the surgery is an outpatient procedure, patients can also return home the same day.

The Benefits & Risks of Tommy John

Tommy John surgery relieves pain and restores proper elbow function. The new UCL ligament is healthy, strong, and allows the patient proper use of the elbow. Post-surgery, the patient must re-build their strength via months of physical therapy and rehabilitation, which could last anywhere from 6 months to a year.

While Tommy John surgery has a high rate of success in allowing pitchers return to the mound, not every athlete returns to his or her pre-injury level of performance. There is also always the risk of re-injury post-surgery if the proper rest and recovery programs are not followed.


While Tommy John surgery has never been more widely performed than it is today, it is a difficult and highly technical operation. UCL injuries are extremely preventable for baseball players by properly warming up, maintaining proper form, and following proper pitch counts and rest day recommendations based on age. Tommy John Surgery is always the last resort and will be considered only after all other conservative treatment options have been exhausted. It’s imperative that pitchers focus on proper body mechanics at all times in order to both preserve the health of their elbow and avoid additional surgeries.

Talk to an Orthopaedic Specialist

When Tommy John underwent the first ulnar collateral ligament reconstruction in 1974, it was estimated that he had a “one in 100” chance of returning to baseball. Today, approximately 85 percent of pitchers who receive Tommy John surgery return to the mound after a year of recovery.

Dr. Timothy Kremchek at Beacon Orthopaedics and Sports Medicine is a board certified orthopaedic surgeon who is fellowship trained in sports medicine and one of the premiere Tommy John surgeons in the nation. Dr. Kremchek is the Team Physician for the Cincinnati Reds and has worked with hundreds of professional, collegiate and high school athletes. With over 1,500 Tommy John surgeries performed, he is uniquely qualified to talk to you about your condition and answer any questions you may have regarding the procedure.  You can schedule an appointment online to meet with Dr. Kremchek at Beacon’s Summit Woods or Wilmington locations.