Triple Tommy John (TJ3) — Surgical Technique

Dr. Christopher Ahmad
4 min readOct 4, 2024

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Warning — Age-Restricted Content Contains Graphic Imagery and Scenes

TJ3 Represents A New Era in Baseball Sports Medicine & Tommy John Surgery

Introducing the revolutionary TJ3 procedure, also known as The Triple Tommy John, a groundbreaking advancement in Tommy John surgery. TJ3 represents a new era in UCL reconstruction, offering baseball players at all levels faster, smoother recoveries with fewer setbacks and extended career longevity. This innovative approach aims to increase success rates and accelerate rehabilitation, meeting the heightened demands o

TJ3 — The Future

Triple Tommy John is a significant advancement in elbow reconstruction. This innovative technique combines native ligament repair with an internal brace and ligament reconstruction, paired with remarkable bio-engineering technology. TJ3 offers a comprehensive solution for athletes with UCL injuries. The initial results are impressive, with several hundred patients benefiting from this cutting edge procedure. During the early phases of rehabilitation, the TJ3 elbows demonstrate tighter flexion, especially in positions where the ligament endures the most stress — an encouraging sign of added resilience. Players also report significantly less soreness throughout their rehab and throwing progressions, contributing to faster recoveries. Most importantly, many athletes are returning to play sooner than expected, showing that the Triple TJ is not just a surgery; it’s a game-changer that could redefine the future of elbow reconstruction in sports!

TJ3 Procedure — Surgical Technique

Warning, graphic surgical images (age- restricted content)

Arm positioned & various skin incisions outlined | Palmaris longus graft identified in the incisions | Palmaris longus delivered out of incision & suture placement
Skin incision to approach the UCL | Forearm muscle split to approach the UCL | Scalpel in position to incise the native UCL
Native UCL incised and tear identified | Tunnel creation on the ulna bone | Tunnel creation on epicondyle
Exit tunnels creation on epicondyle for docking | Tunnel creation for suture anchor and internal brace | Tapping the tunnel for anchor placement
Internal brace anchor placed | Repair Stitch Tensioned showing native UCL repair at bottom of UCL | Stitch placement at top of UCL for UCL repair
UCL graft in place and internal brace in place | UCL graft suture placement | UCL suture placed
UCL sutures tied. Final construct of the UCL reconstruction

TJ3 Procedure — Full Surgical Video

Warning, graphic surgical scenes (age- restricted content)

Dr. Ahmad Walks Us Through His Latest Triple John Surgery — Step by Step

What Exactly Is The Internal Brace & What Is It Made Out Of?

The internal brace, a critical advancement in modern UCL reconstruction,
represents a remarkable blend of bioengineering — combining strength with biocompatibility to provide enhanced support for the repaired ligament. Picture a high-tech rope designed to restore elbow stability, crafted from specialized materials that work together seamlessly. This “tape’ known as Arthrex Collagen Coated Tape, consists of two main components: ultra-high-molecular-weight polyethylene (UHMWPE) fibers and collagen. The UHMWPE fibers are a super-strong plastic, similar to materials used in fishing lines or bulletproof vests, providing the core strength of the tape. This incredible durability is crucial for reinforcing the UCL, allowing it to withstand the immense forces generated during pitching.

However, strength alone is not enough. The tape must also be biocompatible to integrate smoothly with the body’s tissues and promote healing. This is where the collagen coating plays a vital role. Collagen, a natural protein found throughout the body, forms a friendly outer layer that encourages the body’s tissues to heal around the synthetic fibers. The unique combination of the strong UHMWPE fibers and the healing properties of collagen makes Arthrex Collagen Coated Tape ideal for UCL
reconstruction. It offers the structural support necessary to protect the repaired ligament while fostering a healing environment, reducing the risk of complications. This innovative approach exemplifies the ongoing advancements in sports medicine, where cutting-edge science and engineering enhance athletes’ recovery and longevity.

Dr. Ahmad Making Tommy John Surgery History

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Dr. Christopher Ahmad
Dr. Christopher Ahmad

Written by Dr. Christopher Ahmad

Dr. Chris Ahmad is one of the world’s top orthopedic surgeons, head team physician for the New York Yankees & NYCFC, and author of the book SKILL.

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