Ask questions that have specific answers. Most families choose a surgeon based on who their insurance covers, who the team doctor referred them to, or who is closest to home — and none of those tells you anything about how the operation will go. Below are the questions I would want asked if this were my own son, along with what a good answer sounds like. A surgeon who does a lot of these will answer all of them without hesitating.
Start with volume
Ask: how many UCL reconstructions do you perform in a year, and how many have you done in total?
This is the first question because it is the one that correlates most reliably with outcome across surgery generally, and because it is easy to answer honestly. There is no magic threshold, but there is a meaningful difference between a surgeon who does this operation weekly and one who does a handful a year alongside knees and shoulders.
A surgeon who does this regularly will give you a number immediately. Vagueness here is itself an answer.
Ask where they trained
Ask: where did you do your fellowship, and did you see and assist on UCL reconstructions during it?
Volume today matters most, but where a surgeon learned the operation explains a great deal about how they perform it. This is not a procedure that can be picked up from a textbook or a weekend course. Judgment in UCL surgery comes from having stood at the table for a large number of these cases before doing them independently — seeing how the ligament actually looks when it is exposed, how tissue quality is assessed, how the nerve is handled, where the bone tunnels go and what is done when something does not go as planned.
A fellowship at a center that performs these frequently means the surgeon assisted on dozens of them under supervision. A fellowship where UCL reconstruction was an occasional case means the learning curve happened later, on patients.
I trained at the Kerlan-Jobe Orthopaedic Clinic under Dr. Frank Jobe, who performed the first ulnar collateral ligament reconstruction in 1974 on Tommy John himself. I assisted him on these cases and watched him perform the operation he invented. There is no better way to learn a procedure than from the person who developed it, and much of how I think about this surgery traces back to that training.
Then ask about technique
What technique do you use, and why that one?
There are several established reconstruction techniques — modified Jobe, docking, and various suspensory-fixation methods among them. You are not trying to determine which is best; the literature does not settle that cleanly. You are listening for whether the surgeon has thought about it. A surgeon who chose a technique deliberately can tell you what it does well and where its limitations are. One who says "it's what I was trained on" and stops there has told you something.
Do you routinely move the ulnar nerve, or only if I have symptoms?
Ulnar nerve irritation is the most common complication of this operation, and rates vary from roughly 4 percent to over 20 percent depending on technique and nerve handling. Transposing a nerve that was working normally roughly triples the reported complication rate. Some techniques include transposition as a built-in step; others reserve it for patients with symptoms beforehand. Either answer can be defensible, but you want the surgeon to know which they do and why.
Will I be in a brace, and for how long?
Practices differ. Some brace for six weeks or more; others, particularly those using suture tape internal brace augmentation, do not brace at all. What matters is that the answer connects to something — the construct, the fixation, the rehabilitation plan — rather than being a default.
What graft will you use, and what happens if I don't have a palmaris longus?
Roughly 10 to 15 percent of people lack the palmaris longus tendon in a given forearm. Your surgeon should have a clear sequence: which graft first, what the backup is, and whether they would use the opposite arm or move to a hamstring graft. They should also be able to tell you how they harvest it, because there is a rare but devastating complication in which the median nerve is taken by mistake, and technique is what prevents it.
Ask for their own numbers
Ask: what is your own rate of ulnar nerve problems, graft failure and reoperation?
This is the question most patients feel uncomfortable asking and the one that separates surgeons most cleanly. A surgeon who tracks their results will answer. A surgeon who has published their results can point you to the paper. A surgeon who has never looked will say something general about the literature.
None of those answers disqualifies anyone. But you are entitled to know which one you are getting.
Ask whether they will tell you not to have surgery
This one matters more than it sounds.
Partial UCL tears are extremely common on MRI in throwing athletes who feel completely fine — documented in 53 percent of asymptomatic players aged nine to thirteen and 65 percent of asymptomatic high school players. Plenty of elbows that show a tear on imaging do not need an operation, and many that do need one should try properly supervised nonoperative treatment first.
A surgeon who recommends reconstruction at the first visit, on the basis of an MRI report, without an examination that reproduces your symptoms and without discussing nonoperative options, is not evaluating you. They are reading your scan.
Ask about rehabilitation before you ask about surgery dates
The operation is a few hours. The recovery is about a year, and it is where most of the variation in outcome actually lives.
Ask whether the surgeon has a written protocol, whether they will provide an interval throwing program, who supervises the progression, and what criteria you have to meet before you are allowed to throw. "We'll figure that out later" is a poor answer for something that will occupy the next twelve months of your life.
Ask what happens if it fails
About 8 percent of reconstructions eventually require revision, usually several years later. Revision outcomes are meaningfully worse — roughly 55 percent of professional pitchers return to their previous level, against 80 to 84 percent after a first operation.
A surgeon who has thought about failure will tell you what they would do, whether they perform revisions themselves, and where they would send you if they do not. A surgeon who treats the question as pessimism has not considered it.
Do not choose a surgeon because they are close to home
This is the one I feel most strongly about, and it is the mistake I see most often.
The surgery and the rehabilitation are not equally portable. The operation happens once. Tunnel position, fixation, graft tensioning and how the nerve is handled are determined in those few hours and are difficult or impossible to undo. Rehabilitation, by contrast, follows a written protocol — a good physical therapist anywhere in the country can execute it, with the surgeon supervising progression remotely and clearing each milestone.
Patients travel to me from across the country for this operation and fly home to rehabilitate with a therapist near them, working from my written protocol and interval throwing program. I have done dozens of these in my current practice. It works because the part that requires specific expertise is concentrated in the operating room, and the part that requires twelve months of consistency is protocol-driven and local.
Choosing a surgeon for convenience gets the priority backwards. No amount of excellent rehabilitation will correct a reconstruction that was done poorly.
None of which means you need to travel. If a surgeon near you does this operation frequently, answers these questions well, and has results they can speak to, that is a good choice and geography is a bonus. The point is that proximity should not be the reason — it should be a tiebreaker.
Red flags
- Recommending surgery at the first visit based on an MRI report, without an examination that reproduces your symptoms
- Any suggestion that the operation will increase velocity, or that it is worth doing on a healthy elbow
- Unwillingness or inability to give you a case volume
- No written rehabilitation protocol and no interval throwing program
- Dismissing questions about complication rates as negativity
- A return-to-play timeline that sounds notably faster than everyone else's
- Pressure to schedule before you have had time to think or get a second opinion
Things that matter less than people assume
A few criteria carry more weight in families' decisions than they deserve.
Whether the surgeon works with a professional team is a weak signal on its own. It indicates they operate at a high level, but team affiliations are also relationships, and plenty of excellent UCL surgeons have none. What matters is volume and results in this specific operation.
Best-doctor lists and rankings vary widely in methodology, and many are driven by peer nomination or by paid placement. They are a reasonable starting point for building a list, not a basis for choosing from it.
And a busy practice with a long wait is not evidence of quality by itself — though for a UCL injury, waiting several weeks for the right surgeon is rarely the thing that changes your outcome.
Get a second opinion if anything feels rushed
This is an elective operation in almost every case. A UCL tear is not an emergency, and taking two or three weeks to get another opinion will not compromise your result.
Bring your actual imaging, not just the report. The images contain information the report does not, and a surgeon reviewing them may reach a different conclusion about whether the ligament is the problem at all.
The bottom line
Choose on volume, training that included real exposure to this operation, technique the surgeon can explain, willingness to share their own results, a real rehabilitation plan, and a demonstrated readiness to tell you that you do not need surgery. Ask about the ulnar nerve, ask about the graft, and ask what happens if it fails. Do not choose on convenience — the operation happens once and is hard to undo, while rehabilitation follows a written protocol and can be done close to home. If a surgeon near you meets these criteria, that is an excellent outcome. If not, the trip is worth it.
References — publish at the bottom of the page, smaller type
- Clain JB, Vitale MA, Ahmad CS, Ruchelsman DE. Ulnar nerve complications after ulnar collateral ligament reconstruction of the elbow: a systematic review. Am J Sports Med. 2018;46(5):1263-1269.
- Camp CL, Desai V, Conte S, et al. Revision ulnar collateral ligament reconstruction in professional baseball: current trends, surgical techniques, and outcomes. Orthop J Sports Med. 2019;7(8):2325967119864104.
- Dugas JR, Froom RJ, Mussell EA, et al. Clinical outcomes of ulnar collateral ligament repair with internal brace versus ulnar collateral ligament reconstruction in competitive athletes. Am J Sports Med. 2025;53(3):525-536.
- Tanaka K, Okamoto Y, Makihara T, et al. Clinical interpretation of asymptomatic medial collateral ligament injury observed on magnetic resonance imaging in adolescent baseball players. Jpn J Radiol. 2017;35(6):319-326.
- Hurd WJ, Eby S, Kaufman KR, Murthy NS. Magnetic resonance imaging of the throwing elbow in the uninjured, high school-aged baseball pitcher. Am J Sports Med. 2011;39(4):722-728.
- Leslie BM, Osterman AL, Wolfe SW. Inadvertent harvest of the median nerve instead of the palmaris longus tendon. J Bone Joint Surg Am. 2017;99(14):1173-1182.
