UCL Reconstruction (Tommy John Surgery) in San Antonio, TX
What Is UCL Reconstruction?
The ulnar collateral ligament is the primary restraint against valgus stress on the medial elbow — the force generated with every throw. Repetitive high-velocity throwing creates a cumulative stress that can attenuate or tear the UCL over time, particularly in baseball pitchers, javelin throwers and other overhead athletes. When the UCL fails, the elbow becomes unstable, velocity drops and medial elbow pain becomes limiting.
UCL reconstruction — colloquially called Tommy John surgery after the major league pitcher who first underwent the procedure in 1974 — replaces the damaged ligament with a tendon graft, typically from the palmaris longus in the forearm or the gracilis in the thigh. In experienced hands with well-selected patients, return-to-sport rates in high-level athletes are high, though the timeline is significant.
Who Needs Surgery?
Not every UCL injury requires reconstruction. Partial tears and low-grade attenuations can sometimes be managed with an active non-operative program including physical therapy and, in appropriate patients, PRP injection. The decision for surgery is driven by the degree of instability, your throwing level and demands and the nature of the tear on imaging.
I have cared for athletes across levels including professional NFL and NHL players, and I approach UCL decisions the same way regardless of the stakes: with the information in front of us and a realistic discussion of the evidence. A pitcher who wants to continue throwing at a high level with an unstable UCL is unlikely to succeed without reconstruction.
Surgical Technique
I perform UCL reconstruction using a docking or figure-eight technique, which provides secure graft fixation and reliable isometric positioning. The graft is passed through bone tunnels drilled in the medial epicondyle and ulna, and tensioned to restore the native valgus stability of the elbow. Ulnar nerve management is addressed as needed — some patients require transposition at the time of UCL reconstruction, others do not.
Recovery
UCL reconstruction carries the most significant return-to-sport timeline in upper extremity surgery. Most pitchers return to competitive throwing at 12 to 18 months. Position players return faster — typically 9 to 12 months. I have experience with accelerated rehabilitation protocols and apply them in appropriate patients, but I am direct that the ligament maturation timeline is biological, not negotiable. Position players on a 12-month timeline is the floor, not a ceiling to negotiate.
I have provided orthopedic care for professional athletes including NFL and NHL players. That experience informs how I approach high-demand athletes at every level.
Ready to take the next step? Call (210) 878-4113 or request an appointment at sportssurgeryspecialist.com.
