Things you need to know about Tommy John Surgery

Are you a cricketer, javelin thrower, or a tennis player? Then you probably don't need to worry about elbow pain, right? Sometimes the main cause of this pain is a tear in a strong ligament inside the elbow. That's when the 'Tommy John surgery' that changes the future of many athletes comes into the spotlight. Let's talk about this in simple terms, A to Z.

Simply put, what is Tommy John surgery?

Tommy John surgery is a surgery that repairs a ligament on the inside of your elbow called the Ulnar Collateral Ligament (UCL) . It is also called `UCL` surgery.

Think of the UCL as a strong rubber band that holds the elbow joint together. When we use our elbow in the same way over and over again, especially when bowling fast or throwing javelin, this ligament can become damaged. This condition is most commonly seen in:

• Baseball
• Softball
• Javelin
• Football (especially players who throw the ball)
• For those who play tennis and similar racket sports.

If you are a recreational athlete, most of the time, this injury can be cured with rest and simple treatment. However, if you are a professional athlete, meaning your entire career is in this sport, this injury can be the end of your playing career. That is when you have to have `UCL` surgery to save your playing career.

In this surgery, your doctor takes a healthy tendon from another part of your body (often from your forearm or behind your knee) and uses it to rebuild the damaged ligament in your elbow. The tendon that is taken this way is called a 'graft' . Sometimes, if it is not possible to get one from your own body, a tendon from a donor may be used. This new tendon is attached to the upper arm bone (humerus) and the lower arm bone (ulna) of your elbow, making it act like a new `UCL` ligament.

After this surgery:

• Your elbow is stabilizing.
• The pain is decreasing.
• The range of motion in the hand is restored.

In some cases, instead of making a full cast, a special device called an 'internal brace' is inserted into the elbow to strengthen the cast.

Why is it called 'Tommy John'? What's the story behind it?

This is a very interesting story. This surgery is named after Tommy John, a famous American baseball player. He was a skilled bowler. In 1974, his UCL ligament in his elbow was completely torn. At that time, such an injury meant the end of a sports career.

However, doctors tried a new surgery to repair his elbow. After the surgery, he missed the entire 1975 season. But to everyone's surprise, he returned to the field in 1976 and played better than ever. Because of his successful comeback, the `UCL` surgery has since been called the `Tommy John surgery.'

How do you prepare before surgery?

Your orthopedic surgeon will explain exactly how to prepare for surgery. Typically, you will need to do the following:

• A complete physical examination: Make sure you are healthy enough to undergo surgery.
• Blood tests: Learn about basic body functions and infection status.
• Imaging tests: An X-ray , CT scan , or MRI scan may be ordered to see exactly what the damage to your elbow is.
• E.C.G. (Electrocardiogram): Check if your heart is functioning properly.
• Dental checkup: Prevent oral infections from spreading through the bloodstream and affecting the surgical site after surgery.

Your doctor will advise you on how long you should stop eating and drinking the day before surgery. Usually, you should stop eating and drinking 12 hours before surgery.

What exactly happens during the surgery?

Before the surgery begins, the anesthesiologist will give you general anesthesia . This means you will be completely asleep. So you will not feel any pain during the surgery.

The surgery usually follows these steps:

1. Arthroscopy: Sometimes the doctor will use a small camera to look inside the elbow joint. This is called an arthroscopy . This can help diagnose and treat other internal injuries while repairing the ligament.

2. Graft Harvesting: If a graft is needed, the doctor will take a 6-7 inch long piece of tendon from another part of your body (usually from the forearm or behind the knee).

3. Removal of damaged tissue: Damaged, torn ligaments and other unnecessary tissue inside the elbow are cleaned and removed.

4.Bone Piercing: Next, two holes are drilled in the ulna bone and three holes in the humerus bone in the shape of a "Y".

5. Inserting the new ligament: The previously removed tendon (graft) is passed through these holes and fixed as a new ligament. Sometimes it is attached to the bones with small screws to make it stronger.

6. Repairing other damage: If the nerves in the elbow (ulnar nerve) are damaged or there are other problems, they are also repaired during this surgery.

7. Stitching the incisions: Finally, the incisions made in the skin are closed with stitches. They are then covered with a clean dressing and a hard splint is placed to immobilize the arm.

This surgery usually takes about an hour and a half, but this time can vary depending on the extent of the ligament damage and whether there are other problems.

What are the benefits and risks of this surgery?

Like any surgery, Tommy John surgery has both benefits and risks.

What is the recovery time like after surgery?

This is the hardest and most important part of the journey. It can take more than a year to fully recover from Tommy John surgery and return to competitive sports. This is a journey that requires patience. You need to follow the instructions given by your doctor and physiotherapist exactly.

Your recovery schedule might look something like this:

When should you see a doctor immediately?

If you experience any of the following symptoms after going home from surgery, call your doctor immediately or go to the nearest hospital's Emergency Department (ETU) .

• Chest pain
• Difficulty breathing
• Fever (greater than 102 Fahrenheit/39 Celsius)
• Excessive bleeding from the surgical site
• Signs of infection at the surgical site (e.g., pus, excessive swelling, odor, redness, or a feeling of warmth)
• New or worsening pain in the elbow, hand, or fingers
• You have severe pain that you cannot control even with the painkillers you have been given.

Tommy John surgery is an amazing surgery that gives professional athletes a second chance. But its success is 90% dependent on how patient and dedicated you are to the rehabilitation process after the surgery.