Elbow Ligament Reconstruction (Tommy John Surgery)

Through an open incision, a tendon graft, often taken from elsewhere in the same arm or occasionally the leg, is used to reconstruct the damaged ligament, restoring stability to the inner side of the elbow. The procedure typically takes one to two hours and is usually day surgery or a short hospital stay.

Assessment includes examination and an MRI to confirm the extent of ligament damage. Because this reconstruction is often considered for athletes, discussion of the demands of the specific sport and realistic recovery timeframes forms part of preoperative planning, alongside standard fasting and preparation.

A hinged brace protects the reconstructed ligament in the early months, gradually allowing more movement as healing is confirmed. This is one of the longer recoveries in upper limb surgery, with a structured, staged rehabilitation programme typically extending over six to twelve months before a return to high-demand throwing activity.

Rehabilitation follows a staged programme, beginning with protected range of motion, progressing through strengthening, and eventually a graduated throwing programme for athletes returning to sport. Regular follow-up allows the pace to be adjusted to the individual's healing and sport-specific demands.

Risks include infection, graft failure, and irritation or injury to the ulnar nerve, which runs close to the reconstructed ligament and can be affected by the surgery or subsequent scar tissue. Recovery is prolonged, and not all patients return to their prior level of throwing performance.

The goal is a stable elbow able to withstand the repetitive stress of throwing or other demanding activities. Most patients experience good restoration of stability and function, though this is a procedure with a long recovery, and a return to competitive throwing sport in particular takes many months of structured rehabilitation.

Elbow ligament reconstruction rebuilds a damaged ligament, most often the ulnar collateral ligament, using a tendon graft to restore stability for throwing and other demanding elbow activities. Recovery is a long, structured process, and most patients regain good functional stability.