UCL Reconstruction Surgery

Ulnar collateral ligament reconstruction surgery is a procedure used to treat an injury of the elbow that tends to occur among athletes indulged in throwing activities like javelin throw and baseball pitchers. Usually, this is used to cure and support the elbow joint by attaching the ulnar and humerus (bone between the elbow and shoulder) bones on the inside of the elbow. It is the major stabiliser procedure of the elbow. It is also known as Tommy John surgery and is named after an athlete, Tommy john.

 

The main purpose of performing Tommy John surgery/ulnar collateral ligament reconstruction surgery is:-

1. To restore the functions and stability of the elbow joint. 
2. To alleviate the signs and symptoms like pain and weakness. 
3. Other non-surgical treatment methods like rest, strengthening exercise and taking non-steroidal anti-inflammatory drugs have not shown their effect.

If the treatment for the ulnar collateral ligament reconstitution is delayed, it may lead to complications of the following types.

1. Infection in the affected joint
2. Swelling may increase, and there are also the chances of blood accumulation in the affected joint.
3. The patient may lose the range of motion.
4. The pain associated with the condition may get worsen with the time

The surgery is done in 3 stages. They are harvesting the graft, Cleaning out the joint, and Securing the graft inside the elbow.

1. Harvesting the graft
   1. The tendon for replacing the torn UCL (ulnar collateral ligament) is called a graft. 
   2. The graft is taken from any of the following parts of the body.
      1. Hamstring tendon
      2. Big toe extensor tendon
      3. Tendon from forearm
   3. After completing the first step, an anesthesiologist may inject the patient with a precise dose of general anaesthesia.
   4. After this, a breathing tube will be inserted through the mouth to the windpipe. It is inserted to assist the breathing during the surgery.
2. Cleaning out the joint
   1. The doctor makes 2 or 4 cuts on the outside of the elbow. It is done to gain easy access to the elbow joint.
   2. Muscles are removed from the path to gain access to the joint.
   3. Damaged tissues are removed from the site.
3. Grafting 
   1. Holes are drilled in the bones.
   2. The harvested graft is then screwed there so that it recreates the UCL.
4. Closure
   1. The incision will be closed using the sutures.
   2. The sutures are then covered with a sterile bandage.

1. The duration of ulnar collateral ligament reconstruction surgery is around 60 to 90 minutes. The average cost of surgery is about Rs 1 to 3 lakhs and depends upon the type of hospital, facilities provided, rate of recovery, and length of stay at the hospital.
2. Inform your doctor about all the medicines you are taking, whether it is a supplement, herbal, or any other that you are taking without a prescription.
3. The doctor may ask you to stop taking medicines like aspirin, ibuprofen, warfarin, and other medicines that make the blood thinner and make it hard to clot. 
4. Stop smoking with immediate effect.
5. Try to reduce the intake of alcohol. 
6. The doctor may ask you to not eat anything before the surgery after midnight.

1. You will be told the time of the surgery. Try to reach the hospital on time. 
2. When you arrive at the hospital premise, you will be checked in by a staff member of the hospital. 
3. After that, you must fill out a consent form before the surgery.
4. Hospital staff will then ask you to change into the surgical gown provided by the hospital.
5. An ID bracelet will also be tied to your wrist. This bracelet contains the name and date of birth of the patient. 
6. An IV is injected into your wrist. All the medicine is given through this IV infusion bottle. After this, you will be wheeled to the operation theatre.

1. The whole procedure of Tommy John's surgery is done under general anaesthesia. Because of this, the patient will not feel any pain or other sensations during the surgery.
2. All the vital signs of the patient, like blood pressure, breathing, and heart rate, are continuously monitored during the time of surgery.
3. Generally, this surgery is an outpatient procedure, and the patient can go home on the same day.
4. An IV infusion is also injected into the arm of the patient. All the necessary medicines are given through this IV during the surgery and in the recovery room.
5. The elbow will be placed in a special rigid brace after the surgery.
6. Around 15 to 18 centimetres of the tendon are required for reconstructing the Ulnar collateral ligament.

1. After the completion of the surgery, the patient is shifted to the recovery room. 
2. All the vital signs are monitored continuously till the patient gains consciousness.
3. The elbow is placed in the brace at around 60-90 degrees. The main aim behind this is to reduce inflammation and protect the healing tissues of the elbow.
4. After 1 or 2 weeks, you can start moving your elbow joint. The main aim of physiotherapy is to increase the range of elbow motion.
5. By the first month's end, you can extend the elbow to full capacity. You may also stop wearing a sling brace if there is no pain.
6. If the person completes his/her full physiotherapy program, then after 2 to 4 months, they can regain a normal range of motion.

 

1. The first follow-up appointment is generally 1 or 2 weeks after completion of the surgery.
2. At the first follow-up appointment, the doctor will check the healing process.
3. The doctor may also decrease the dose of painkiller medicines at the first appointment.
4. If any splint is present over the dressing, it may be removed at the first follow-up. After the removal of the splint, you can start your physiotherapy sessions.

Immediately call a doctor when you have started feeling any of the following manifestations:-

1. Complications associated with the dose of anaesthesia such as breathing problems
2. Bleeding from the incision site
3. Numbness and weakness in the operated limb or area
4. Formation of a clot in deep blood vessels
5. Infection in the wound
6. Damage to the nerves surrounding the site if incision.
7. Unable to fully extend the elbow
8. Feeling chronic pain when throwing something