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Keeping the Dream Alive for High School Students who need Tommy John Surgery

UCL Primary Repair With Internal Brace

Last week I performed a standard Tommy John surgery on a college pitcher. The Tommy John surgery took 45 minutes. The length of rehab will be much longer. To be more exact, it will take 12 months before he can be expected back in a game. Major leaguers take an even lengthier 14–16 months to return to a major league game.

For many athletes, the time for return is detrimental to their recruitment, their contract, their personal practice and development, and weighs heavily on their psyche. Some players choose not to have the surgery because they may not be playing baseball if out for a full year. One of my biggest areas of interest in Tommy John surgery is to accelerate the healing time. And finally, I can offer a tremendous breakthrough.

Tommy John Surgery requires transplanting a tendon graft that needs to undergo a biologic transformation to mature into a sturdy strong UCL. Trying to cut down the healing time and accelerate the progression from easy throwing to hard pitching required in the rehab has caused many setbacks for many pitchers.

On the other hand, UCL primary repair with internal brace is a surgical technique that avoids using a tendon graft and instead directly repairs the athletes’ own native ligament. The healing time for non-transplanted native tissue is ½ that of transplanted tendon tissue. In addition, a special internal brace is incorporated with the procedure. The braces are made from ultra-high-strength braided polyester that protects the ligament during the healing process. It functions like a seatbelt.

Keeping Athletes Dreams Alive

So why doesn’t everyone with a UCL injury have ligament repair with the internal brace? Not every tear pattern is amenable to repair. The ligament maintains overall good quality with a focal area of injury. An example is an injured ligament that detached from the bone. (Figure 1) The ligament quality is tremendous, does not need to be replaced, but instead needs reattachment to the bone.

In contrast, a UCL that explodes and turns into oatmeal, will not heal and needs Tommy John surgery. Some UCLs have chronic changes such as calcifications and these situations do not lend themselves to UCL repair.

Figure 1 — The ligament maintains overall good quality with a focal area of injury. The ligament quality does not need to be replaced but instead needs reattachment to the bone

Which pitchers have absolutely loved their UCL primary repair with internal brace surgery the most? I take care of a huge number of high school athletes who wish to play in college. The sophomore in HS who gets injured in June or July during summer ball loves primary UCL repair w/ internal brace. If he gets standard TJ surgery, he will miss his junior year which compromises his college recruitment. If he is a candidate for primary UCL repair, repair with internal brace gets him back for his junior year and keeps his dream alive. Many high school players are great candidates for UCL primary repair because their ligament has not undergone chronic changes observed in professional pitchers.

Yesterday, I performed 4 elbow surgeries. 2 of them were classic Tommy John surgeries on college pitchers, 2 were UCL repairs with internal braces on HS players.

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