UCL Reconstruction (Tommy John Surgery) for Teen and Young Adult Athletes

Reviewed by Michael Beasley, MD, FAAP, CAQSM, FAMSSM Joseph L. Yellin, MD Apurva S. Shah, MD, MBA

Reviewed on 02/20/2026

What is UCL reconstruction (Tommy John surgery) for teen and young adult athletes?

Grade 3 Injury — In a grade III elbow injury, the UCL ligament has completely torn. This type of injury often requires reconstruction, or Tommy John surgery.

The ulnar collateral ligament (UCL) is a ligament on the inner side of the elbow that helps to keep it stable and intact. A UCL injury may occur due to:

Long lasting (chronic) changes to the ligament over time from repeated throwing or overhead motions (overuse)
Sudden injury caused by a specific incident (acute injury) where the ligament becomes stretched or torn
A combination of the two

If this happens to your athlete, they may need a surgical procedure called UCL reconstruction. UCL reconstruction is more commonly known as Tommy John surgery (named for a Major League Baseball pitcher who was the first baseball player to have the surgery).

This elbow surgery for throwing or stress-related injuries rebuilds the damaged ligament to restore strength and stability, allowing your athlete to safely return to the sports they love.

When is UCL reconstruction needed?

Most UCL injuries start with overuse. In many cases, rest, physical therapy and rehabilitation can help the ligament heal. But when the ligament is completely torn (a Grade III injury) or when pain and weakness continue despite nonsurgical treatment for a partial tear, we may recommend UCL reconstruction.

Here at Children’s Hospital of Philadelphia (CHOP), we perform this surgery most often for:

Teen and college baseball players, especially pitchers
Throwing or overhead athletes in sports like softball, javelin, volleyball or certain positions in football, who also experience repetitive stress on the elbow
Gymnasts or wrestlers who experience acute injuries to the elbow

Your CHOP orthopedic or sports medicine specialist will help determine if UCL reconstruction is the best option based on the severity of the tear, your child’s activity level and their long-term goals.

Elbow Surgery FAQ Guide for Parents

Has your child been diagnosed with an elbow injury? It’s normal to have questions about treatment and returning to sports. Fill out this form to access our free Elbow Surgery FAQ guide for expert insights.

What happens during Tommy John surgery?

During Tommy John surgery, surgeons rebuild your athlete’s UCL ligament using healthy tissue from their forearm or hamstring, or sometimes from a donor (a tendon graft).

During the procedure:

The surgeon identifies the damaged ligament tissue.
Small tunnels are made in the arm bones around the elbow.
The tendon graft is threaded through these tunnels and secured under tension to recreate a new, stable ligament.

Advances in surgical techniques and rehabilitation have made UCL reconstruction highly successful, even for younger athletes who are still growing.

It is important to note that unlike a UCL repair (which reattaches and reinforces a partially torn ligament), UCL reconstruction creates a new ligament, offering strong long-term stability for athletes who wish to return to playing sports that place high stress on the elbow. Your CHOP doctor will help decide whether a UCL repair or reconstruction will offer your child the best possible outcome with the quickest recovery.

When the injury to the UCL ligament is severe (a complete tear), elbow reconstruction surgery is typically the recommended treatment. This is known as Tommy John surgery.

The goal of Tommy John surgery is to rebuild the damaged ligament and restore strength and stability so a player can safely return to sports.

The surgeon will choose healthy tissue from a part of your child’s body, such as an arm (or sometimes from a donor). That healthy tissue will then be harvested so it can be grafted to the injured ligament.

The surgeon will make a small incision on the inside of the elbow and carefully examine the surrounding structures, including nearby nerves, to safely access the injured ligament.

Small holes will be drilled into the bone so the so the new healthy tissue can be placed in the elbow.

The new tissue (graft) will be secured to the bones of the elbow using special suturing techniques that allow it to heal in the correct position. This creates a new stable ligament.

The skin will then be sutured, leaving behind a small scar.

How long will it take to recover from UCL reconstruction?

Recovery from Tommy John surgery takes time. Typically, you can expect your athlete to spend about six to 12 months in recovery before returning to full competition, depending on their sport and post-operative rehabilitation. Rehabilitation includes bracing, structured physical therapy and a gradual return to play. With patience and the right support, most athletes make a solid comeback. Our goal is to have athletes return to their pre-injury level of play, or stronger.

Typical recovery timeline

The UCL recovery time for your athlete might look like this:

Phase 1: Protection & Healing – For the first six weeks after surgery your child will wear a brace to gradually increase motion while their elbow heals, as well as incorporate motion exercises for their shoulder and wrist, and core strengthening exercises.
Phase 2: Strengthening – Between six weeks and three months after surgery, your athlete should have established full range of motion and will gradually work on strengthening the elbow and shoulder, beginning with light exercises. They will eventually advance to more involved strengthening with the goal of achieving 85% strength as compared to the uninjured side.
Phase 3: Advanced Strength & Control – Between four to six months after surgery, your athlete will begin:
- Progressive resistance and strength training
- Balance exercises
- Functional movement and conditioning to help make sure their muscles, joints and tissues are working together efficiently
- Batting and progressive plyometric exercises
Phase 4: Return-to-Throwing Program – After six to nine months, your throwing athlete may be ready for structured throwing and overhead activity progressions, where they can begin to retrain their elbow mechanics with guidance from a CHOP physical therapist.
Phase 5: Return to Competition – After nine to 12 months, your athlete may be ready to make a full return to sport after they’ve been cleared by their surgical and rehab team.

The timeline is not one size fits all, and will depend on your athlete’s injury, age and stage of growth. Their recovery will include several checkpoints and functional testing to assess these progressive milestones, guiding safe increases in activity based on healing and function. Your team of CHOP doctors will ensure your child's elbow responds well as activity increases. It’s important that they regain strength safely to reduce the risk of re-injury.

Returning to sports after Tommy John surgery

Most athletes can return to their previous level of play after full recovery and a new emphasis on stretching, strengthening and injury prevention. Success rates for UCL reconstruction in young athletes are typically above 80%.

Return-to-play timelines depend on:

The type of sport your athlete plays and their position
How well your athlete progresses in physical therapy
Your child’s individual rate of healing

Open communication between the patient-athlete, their parents, the CHOP surgeon and other members of the team, including physical therapists, athletic trainers and sports coaches, is essential to ensure a safe, confident return to play. Our priority is making sure the elbow heals properly and regains strength, motion and stability to support long-term function and reduce the risk of them becoming re-injured.

Long-term outlook after Tommy John surgery

With proper care and rehabilitation, most athletes can enjoy a pain-free, stable elbow and a full return to competitive sports. Re-injury is uncommon if your athlete follows preventative guidelines (like pitch counts for throwing athletes) to help avoid future ligament stress.

80–90% of athletes return to their prior level of play after UCL reconstruction.
Repair procedures show promising results with even shorter recovery in some young athletes.
Long-term studies show that most patients maintain pain-free motion and stability for years after surgery.

Risks and considerations

As with any surgery, there are potential risks, including:

Nerve irritation (most commonly the “funny bone” or ulnar nerve)
Re-injury or incomplete healing
Elbow stiffness or loss of motion
Complications related to the harvested tendon graft

Your CHOP surgeon will review these risks and the steps we take to minimize them. Our team will make the final decision about surgery in collaboration with your child and your family. In adolescents, we are mindful of the implications of growing athletes and open growth plates to ensure the best long-term outcomes possible for your child.

Why choose a team experienced in UCL reconstruction in young athletes

UCL reconstruction surgery in teens and young adults does not have a one-size-fits-all formula. It requires a deep understanding of both elbow anatomy and the demands of sports that can put stress on the elbow.

UCL surgery should be performed by a surgeon experienced in treating athletes whose bodies are still growing. Look for a team that:

Specializes in adolescent and young adult sports injuries
Performs high volumes of UCL repair and reconstruction
Offers comprehensive rehabilitation with sports physical therapists
Works closely with families, coaches and athletic trainers

Here at CHOP, your athlete’s care team includes:

Orthopedic surgeons specializing in both pediatric sports medicine and adult sports medicine
Sports medicine physicians, physical therapists and athletic trainers skilled in rehabilitating throwing and overhead athletes with growing bones, who can guide your athlete’s safe return to play
Nutritionists, advanced practice nurses and physician assistants who conduct sports-specific wellness assessments, conditioning and nutrition programs to help us treat the whole athlete

Our goal is not just to repair your child’s elbow, but to help them return stronger, safer and more confident than before – both in sports and in life.

Frequently asked questions

How long is recovery after Tommy John surgery?
Most athletes return to competition within nine to 12 months, though full recovery may take longer for certain throwing athletes, like pitchers .

How long before I can throw again after UCL surgery?
Most athletes begin a supervised throwing program around six to seven months after surgery, as long as strength and functional milestones have been met. The return to full competition is typically nine to 12 months, depending on the type of procedure and the athlete’s position.

What’s the difference between UCL repair and UCL reconstruction?
UCL repair reattaches and reinforces a partially torn ligament, or a completely torn ligament that might respond well to repair (usually a Grade II injury or some acute Grade III injuries). UCL reconstruction replaces a completely torn ligament entirely with a tendon graft. Your doctor will help decide whether a UCL repair or reconstruction will offer your child the best possible outcome with the quickest recovery.

Can I have Tommy John surgery twice?
Yes, revision surgeries are possible, but outcomes are best after the first procedure when rehab protocols are followed carefully.

Is Tommy John surgery safe for teenagers?
Yes. When performed by experienced pediatric sports surgeons, the procedure has a high success rate and a strong safety record. If your teenager is still growing, your orthopedic surgeon will consider open growth plates when deciding on the best treatment options.

Can UCL surgery make me throw harder?
UCL reconstruction surgery is designed to restore elbow stability, but the surgery alone does not enhance performance. Strength and velocity return with proper rehab, conditioning and your body’s mechanics.

What happens if I rush back too soon?
Returning before being fully healed increases the risk of re-injury and prolonged downtime. Following your recovery plan is key to long-term success.