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UCL Repair

Updated: May 5, 2022

Tommy John surgery or Ulnar Collateral Ligament (UCL) reconstruction is one of the most feared surgeries in baseball. The UCL reconstruction surgery got its name from the first patient, New York Yankees pitcher Tommy John. In 1974, Dr. Frank Jobe performed what was then an unknown surgery to try and save John’s career as an MLB pitcher. After the surgery, John would go on to continue pitching in the major leagues for years afterwards, and a new surgery was born.

Surgeries are created to fix a problem, but they are not meant to be a primary response. Amazingly, some people still believe that UCL reconstructive surgery will increase velocity in pitchers. This is not the case. Also, Tommy John surgery prevalence continues to increase every year, and patients are becoming younger and younger. The goal of medicine is to provide the minimal effective dose. Imagine that you have a really bad headache. You do not take 10 Advil even though that is probably more effective than taking 2. There are consequences of taking too much medication, so research tells you how many pills are necessary for the desired result. Unfortunately, UCL reconstruction is similar to taking a lot of Advil. It will probably fix your elbow, but there are consequences (we will talk more about them later).

We have now highlighted a brief history of UCL surgery, but it is important to understand that there have been alternatives attempted in the past. During UCL reconstruction, the ligament is completely replaced by a tendon from somewhere else in the body. Some surgeons have tried to simply repair the ligament, rather than fully replace it, but the results were not good.

However, technology has progressed and surgeons and researchers have begun to utilize new techniques including “internal bracing”. This involves essentially using tape to repair the damaged ligament without replacing it. We have come a long way in medicine in understanding what the body tolerates and will allow for healing, and the “tape” involves several biological facto