Tommy John Surgery | Cost | Indications

Tommy John Surgery | Cost | Indications | Techniques

Overview

Tommy John Surgery

Baseball players, gymnastics, footballers, and offensive linemen are all susceptible to medial elbow pain. The most frequent source of wasted time is elbow injury.

The upper extremity accounts for roughly half of all injuries among baseball players, with the elbow accounting for 10% of all injuries.

More than 95% of elbow pain occurs on the medial aspect (where the ulnar collateral ligament is present).

The numbers of ulnar collateral ligament impairment are constantly rising. The number of players who have had their ulnar collateral ligaments reconstructed has risen dramatically.

Revision surgery is becoming more common in Baseball players and other sportsmen, although it is uncommon.

What is Tommy John Surgery?

What is Tommy John Surgery

Ulnar collateral ligament reconstruction, also known as Tommy John surgery, is a procedure that replaces a damaged ulnar collateral ligament within the elbow joint with a tendon from another portion of the body.

The surgery’s main objective is to strengthen the elbow, relieve pain, and reestablish stability and physical function.

In overhead pitching sportsmen, it is among the most regularly done surgical intervention.

There are several techniques of UCL reconstruction with the docking technique being the most commonly performed variety.

Indications of Tommy John Surgery

The following are both criteria for surgical repair of an ulnar collateral ligament damage
• A complete tear
• Failure of prolonged conservative therapy of a partial UCL tear

The gold standard for the operational management of a complete UCL tear is still ulnar collateral ligament reconstruction.

Both the modified Jobe technique and the docking technique have demonstrated good outcomes, with success rates ranging from 80 to 90 percent.

Ulnar collateral ligament repair with collagen suture tapes augmentation has lately garnered attention. Long-term outcomes, unfortunately, are limited.

Contraindications of Tommy John Surgery

There are limited contraindications of this surgery and include the following:
• Inability or desire to finish the intensive postoperative rehabilitation process.
• Significant ulno-trochlear or radio-capitellar arthritic diseases

Equipment of Tommy John Surgery

Few tools are required to perform this procedure and encompass the following:
• Tendon stripper to harvest the graft
• Drills or burrs
• Looped stainless steel wire on curved needle
• Ethibond and vicryl sutures

How Tommy John Surgery Performed?

We will discuss the most commonly performed technique docking technique. This procedure is done under local anesthesia with sedation.

• Extraction of Palmaris Longus Tendon
An incision is made over the palmaris longus tendon at the proximal wrist crease to extract the tendon.

An Ethibond suture is used to put a Krakow suture in the distal end of the tendon. The tendon is sharply removed distally to the suture, and the tendon is extracted proximally with a tendon extractor.

Sutures are not inserted in the proximal end, which is kept free for the time of insertion. The tendon is placed in a saline sponge on the corner table, and the wrist wound is closed. After that, the medial aspect of the elbow is inspected.

• Preparation of Docking Site
The ulnar collateral ligament’s humeral footprint is subperiosteally recognized. To a depth of 15 mm, a drill or burr is used to form a hole in the middle of the footprint.

This hole is pushed proximally and posteriorly, but the ulnar nerve should be protected and the distal cortex shouldn’t be penetrated. Drilled two sockets converge with a single socket.

• Passage of the Graft
The endogenous ulnar collateral ligament and capsule are sealed with the elbow at 30 degrees of flexion and a small varus load is applied once all sockets have been set.

• Graft Tensioning and Maintenance
The sutures leaving the anterior socket are tensioned and maintained. The graft’s opposite limb is pulled tight against the socket. At this entry point, the graft is visible.

• Final Fixation
Rotating the graft is done by repeatedly bending and stretching the elbow whilst maintaining stitch tension.

After that, the elbow is flexed 30 degrees, gently put in varus position, then supinated. Over the bony bridge, sutures are tightly secured.

How Long Does Tommy John Surgery Last?

Tommy John surgery is usually performed on an outpatient basis. This usually indicates that you can come back home the same day. It takes 1-2 hours to complete.

Risks of Tommy John Surgery

The following are possible complications of UCL reconstruction:
• The replaced tendon may stretch or tear, necessitating repeated reconstruction procedures.
• Numbness or weakness caused by a transient or persistent neuropathy.
• Ulnar neuropathy requires extra surgeries.
• The elbow is unable to stand straight.
• When throwing, there is a lot of pain