Tommy John Graft Harvest


Tommy John requires reconstructing or rebuilding the ulnar collateral ligament. The requires the use of graft tissue. The graft tissue needs to be strong and have capacity to biologically heal. The options are typically the palmaris longus tendon from the forearm or the gracilus tendon from the knee.


  • Dr. Alkhatib’s preferred graft choice when it is present and of adequate size.
  • 20% of people do not have a palmaris and a small percentage of patients will have a small palmaris.
  • The palmaris longus has no essential function and can be taken from the throwing arm without future compromise to throwing ability.
  • If the palmaris is absent or small, a gracilus tendon from the knee is used


  • Used if the palmaris is too small or not present, second Tommy John Surgery, or occasionally if UCL tear is associated with calcification within the ligament.
  • Part of the hamstring muscle group.
  • Gracilus commonly used for revisions 
  • Gracilus tendon often used in ACL Reconstructions (knee ligament)
  • No significant observed compromise to knee function for pitching

(Dr. Alkhatib has pitchers throwing over 100mph in MLB following UCL recon with Gracilus tendon graft)

  • Harvested through a small incision in the front of the knee