The ulnar collateral ligament, or UCL, is a band of fibrous tissue connecting two bones – the humerus in the upper arm and the ulna in the forearm on the inside of the elbow. If you didn’t have that ligament, there would be a gap between the two bones.
This ligament plays a critical role for athletes who throw, such as football quarterbacks and baseball pitchers, because it serves as an anatomical bridge. The UCL transmits the force of the throw from the shoulder to the hand as the ball is released.
But here’s the problem: The force on the elbow generated by pitching a baseball, especially from today’s high-velocity pitchers, exceeds the strength of the ligament.
Poor mechanics and other factors stress the ligament to the point where it can tear, thus causing the need for repair. To replace the torn tissue, the surgeon typically takes a relatively unused tendon from the pitcher’s forearm or hamstring.
Arms brought back to life
Before this surgery, a tear of the UCL ended many major league pitching careers.
Case in point: Sandy Koufax, the Los Angeles Dodgers pitcher and Hall of Famer, retired in 1966 because of severe elbow pain. Koufax was only 30 years old and at the zenith of his career. Frank Jobe, the doctor who performed the first Tommy John surgery and the Dodgers’ team physician at the time, said the procedure could have been called Sandy Koufax surgery had he developed the idea earlier.
Returning to play after Tommy John surgery is not without difficulties, and recovery takes a long time; John took close to two years before he could pitch again. Although today’s surgery is much less invasive, recovery takes about a year.
About 80% of pitchers successfully return to playing after the surgery. But sometimes the repair doesn’t last forever, and about 30% of pitchers with repaired elbows undergo a second surgery.
A surge in surgeries
Since Tommy John, it’s estimated that nearly 2,500 professional baseball players have undergone the surgery, and the number of overall procedures increases about 9% a year.
One-third of current Major League Baseball pitchers had Tommy John surgery at some point. Shohei Ohtani, the Dodgers’ two-way superstar, had the procedure in 2023. While Ohtani returned to batting in 2024, he’s not expected to pitch until 2025.
There are several reasons why the number of surgeries have increased. First is the addition of a pitch clock in 2023, which works like a shot clock in basketball – pitchers must throw their next pitch within a certain time frame.
The rise of the sweeper pitch has also made an impact. This high-velocity breaking ball has been blamed for stressing the UCL.
The ulnar collateral ligament, or UCL, is a band of fibrous tissue connecting two bones – the humerus in the upper arm and the ulna in the forearm on the inside of the elbow. If you didn’t have that ligament, there would be a gap between the two bones.
This ligament plays a critical role for athletes who throw, such as football quarterbacks and baseball pitchers, because it serves as an anatomical bridge. The UCL transmits the force of the throw from the shoulder to the hand as the ball is released.
But here’s the problem: The force on the elbow generated by pitching a baseball, especially from today’s high-velocity pitchers, exceeds the strength of the ligament.
Poor mechanics and other factors stress the ligament to the point where it can tear, thus causing the need for repair. To replace the torn tissue, the surgeon typically takes a relatively unused tendon from the pitcher’s forearm or hamstring.
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