What’s the success rate for the Tommy John elbow surgery? I know I have to have it because I failed therapy and I was very diligent with my exercises. I’m wondering how likely it is I’ll be able to get back on the team and play real ball again.

The Tommy John procedure is designed to reconstruct (not just repair) the ulnar collateral ligament (UCL). The ulnar collateral ligament is located at the elbow. It supports the humerus-to-radius connection and helps stabilize the elbow. The humerus is the upper arm bone. The radius is one of the bones in the forearm. Without this ligament, the force generated by the throwing motion on the medial side of the elbow (side closest to the body) is enough to potentially dislocate the joint.

In the Tommy John operation, the ulnar nerve is moved away from the bone. A piece of fascia (connective tissue) is used like a sling to hold the nerve in its new place. During the same procedure, the damaged ulnar collateral ligament (UCL) is replaced with a piece of graft tendon tissue.

The Tommy John procedure is used when the loss of an intact ulnar collateral ligament results in an unstable elbow joint. Overhead throwing athletes must have a stable, intact elbow in order to have the speed and accuracy needed for the wind up, cocking, acceleration, deceleration, and follow-through phases of overhead pitching.

In a recent study from the American Sports Medicine Institute in Birmingham, Alabama, an 83 per cent success rate was reported for the 942 patients who had this procedure. Most of the patients in this study were baseball pitchers. Success was defined as return-to-sport at the preinjury level of participation.

Besides baseball pitchers, a smaller number of other athletes were included. There were baseball catchers, outfielders, and infielders. Athletes involved in other sports included football players, javelin throwers, tennis players, wrestlers, soccer players, gymnasts, cheerleaders, and pole vaulters.

Not only was there an 83 per cent success rate (athletes returning to pre-injury level of play), almost half of the patients (41 per cent) advanced to a higher level of play. Some of the athletes were able to move from a minor league to major league; others moved up from amateur to professional baseball.

Only a small number of patients (11 per cent) did not return to sports participation at all.

The time from surgery to throwing was about four and a half months. Some patients advanced to throwing skills as early as the third month. Others took up to a full year to achieve this milestone. Full participation at a competitive level was longer in coming (ranging from three to 72 months).