Elbow collateral ligament reconstruction is an operation to repair or reconstruct a torn ligament of the elbow. UCL reconstruction (Tommy John surgery) is performed for medial instability in throwing athletes. LCL reconstruction is performed for posterolateral rotatory instability.
An incision is made on the inner (UCL) or outer (LCL) side of the elbow. For UCL reconstruction: a tendon graft (usually palmaris longus from the forearm) is passed through tunnels drilled in the humerus and ulna to recreate the ligament. For LCL repair: the torn ligament is reattached to bone using suture anchors. The operation takes one to one and a half hours.
UCL reconstruction is recommended for throwing athletes with symptomatic medial elbow instability. LCL reconstruction is recommended for posterolateral rotatory instability causing recurrent elbow subluxation or dislocation.
Physiotherapy, activity modification, and bracing. For UCL injuries, many non-throwing athletes manage well without surgery.
MRI and stress X-rays. For UCL reconstruction, a detailed throwing history and assessment.
UCL reconstruction allows approximately 80-85% of throwing athletes to return to their previous level of competition. LCL reconstruction reliably restores elbow stability.
Some loss of full extension is common.
Pain at the tendon donor site.
The ulnar nerve may be irritated. May require transposition.
The reconstructed ligament may stretch or fail.
Wound infection.
Despite reconstruction.
General or regional anaesthesia.
UCL: Brace for six weeks. Throwing programme begins at four months. Return to competitive throwing at nine to twelve months. LCL: Brace for six weeks restricting varus stress. Return to full activity at three to six months.
Reviews at two weeks, six weeks, three months, and six months.
UCL reconstruction is commonly called Tommy John surgery after the first baseball pitcher to undergo the procedure in 1974. It has become a well-established operation for throwing athletes.