June 1, 2024
Tommy John 2.0 – Building on Excellence in UCL Reconstruction Surgery
By: Carlos Uquillas, MD. Cedars Sinai Kerlan-Jobe Institute.
For 50 years, Tommy John Surgery, the official term being ulnar collateral ligament (UCL) reconstruction, has been the gold standard for treating torn UCLs in athletes. Traditionally involving tendon graft and lengthy rehabilitation, a UCL tear, and the procedure to correct it, has sidelined countless pitchers and other throwing athletes. But the winds of change are blowing in sports medicine, and a hybridized approach – using internal bracing– offers a potentially more robust and faster path to recovery.
The traditional Tommy John Surgery involves harvesting a tendon from the forearm to replace the torn UCL. This graft is then secured to the bone using screws or sutures. While highly successful in restoring ligament stability, the surgery has a significant downside, especially for elite and professional athletes: a lengthy and demanding rehabilitation process. Athletes often face a full year before returning to competitive throwing, which can significantly strain their playing careers.
UCL Reconstruction: Docking technique and Internal Brace Augmentation
The addition of artificial internal bracing, combined with the ligament replacement in Tommy John Surgery, aims to address the recovery hurdle many athletes face. The innovative approach of the internal brace utilizes synthetic ligament augmentation rather than tendon graft. During surgery, the torn UCL is repaired, and then a high-strength suture tape is woven through the native tissue of the ligament and secured to bone anchors. This “internal brace” provides additional support and stability during the healing process, potentially allowing for a more aggressive rehabilitation protocol.
The critical advantage of internal bracing in UCL repair is its potential to accelerate recovery. Early studies suggest that athletes using this system regain throwing functionality quicker compared to the traditional graft technique. This could translate to a shorter return-to-play timeline, a crucial factor for professional athletes whose careers hinge on peak performance.
Another potential benefit is the minimally invasive nature of the surgery. The internal brace procedure often uses a smaller incision than the traditional approach, potentially leading to less tissue disruption, faster healing, and improved cosmetic appearance.
While the hybridized approach to Tommy John Surgery with the addition of internal bracing shows promise, it’s essential to maintain a balanced perspective. This approach is still relatively new, and long-term data on its effectiveness is still being gathered. Additionally, internal bracing might not be suitable for all cases of UCL reconstruction – a notion true for any procedure, anywhere in the body. Humans are not “one size fits all,” and neither are the treatments that aim to correct what ails them. The decision to use this approach must be made individually with expert physicians, considering factors like the severity of the UCL tear, the athlete’s age, specific life circumstances, and overall health status.
As with any new surgical technique or augmented approach, ongoing research is crucial for refining procedures to enhance Tommy John Surgery and establish a trusted place within the treatment landscape. Studies are already underway to evaluate the long-term outcomes of this approach and compare it directly to traditional Tommy John surgery. Additionally, surgeons are constantly developing new, less invasive ways to utilize internal bracing, enhancing its potential benefits.
The emergence of internal bracing as an enhancement to traditional Tommy John Surgery represents an exciting development in the world of sports medicine, and the Kerlan-Jobe Institute is once again honored to be leading the way. This technology offers the promise of an enhanced approach to Tommy John surgery, potentially giving athletes a significant edge in their recovery journey. At the 50-year mark of Tommy John surgery, much clinical research and evidence indicates its efficacy. Determining the effectiveness of augmenting this time-honored and well-researched procedure with internal bracing will also take time to evaluate. For now, internal bracing signifies a step towards a future where throwing injuries don’t have to derail athletic careers for as long as they might today.
Sources:
https://apnews.com/article/ohtani-dodgers-elattrache-9
https://apnews.com/article/ohtani-dodgers-elattrache-9a87de3cf0ea31d1bb78420d6b505cc7
https://www.webmd.com/fitness-exercise/tommy-john-surgery-ucl-reconstruction
