Tommy John Surgery
(UCL Reconstruction)

Tommy John Surgery, also known as ulnar collateral ligament (UCL) reconstruction, is a procedure designed to repair a torn or damaged UCL — a key ligament on the inside of the elbow. This injury is especially common in overhead athletes, particularly baseball pitchers, due to repetitive throwing motions.

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The ulnar collateral ligament stabilizes the elbow during activities that involve bending and twisting, such as throwing a baseball. When this ligament is overstressed, it can stretch or tear, leading to pain, instability, and reduced performance. In athletes, a UCL injury can be career-altering if left untreated.
UCL injuries most often occur due to repetitive stress from overhead throwing or trauma from a sudden elbow dislocation or hyperextension. Athletes may feel a “pop” or tearing sensation followed by pain along the inner elbow, swelling, reduced velocity, or a loss of control while throwing.
Dr. Romanelli will perform a detailed physical exam and may use imaging such as an MRI or MR arthrogram to assess the severity of the UCL tear. He may also evaluate other soft tissue structures in the elbow to determine whether surgery is necessary.
Tommy John Surgery involves reconstructing the torn UCL using a tendon graft, usually harvested from the patient’s own forearm, hamstring, or another donor site. The new graft is threaded through tunnels drilled into the humerus and ulna to recreate the original ligament’s structure.

This procedure typically lasts about 60–90 minutes and is performed on an outpatient basis under anesthesia.
Recovery from Tommy John Surgery is a structured and gradual process. Initial rest is followed by physical therapy to restore range of motion, strength, and eventually return to sport. Most athletes can begin a throwing program by 4–6 months post-op, with a full return to competitive throwing typically occurring around 12–18 months.

With expert surgical care and disciplined rehab, many athletes are able to return to — and even exceed — their pre-injury performance.