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Dr. Garcia demonstrates his technique for acute elbow dislocations: LUCL repair with internal brace.
Dr. Garcia specializes in complex knee, shoulder and elbow sports surgeries. He has prepared a number of surgical videos below to help patients better understand their procedures. He is frequently updating his surgical video database so check back soon for further updates.
This video features Dr. Grant H. Garcia demonstrating his surgical technique for a lateral ulnar collateral ligament (LUCL) repair enhanced with an internal brace. The patient in this case suffered multiple recent elbow dislocations, resulting in a complete avulsion injury where the LUCL torn completely off the capitellum (humerus).
Here is a summary of the procedure shown in the video:
- Exposure and Suture Placement: The surgeon dissects out the avulsed LUCL complex and exposes the corresponding anatomy on the ulna and humerus. A Krakow stitch is placed through the avulsed LUCL tissue using suture tape, ensuring the ligament remains flat so it can be restored perfectly to its native, anatomic position.
- Ulnar Anchor Fixation: A 3.75 SwiveLock anchor loaded with fiber tape is placed into the ulna, approximately six millimeters away from the joint line. This anchors the distal portion of the internal brace.
- Isometric Spot Testing: The surgeon tests the construct to identify the most isometric point on the capitellum—the spot where the distance between the two anchors changes the least during normal elbow movement. Once found, this location is drilled and tapped for a 4.75 SwiveLock anchor.
- Tensioning and Humeral Fixation: To prevent over-tightening and over-constraining the elbow joint, the insertion depth is carefully marked on the fiber tape. With the patient's arm positioned at 45 degrees, a free needle is placed underneath the fiber tapes to preserve just enough slack. The surgeon fully tightens the native tissue repair portion while malleting the 4.75 SwiveLock anchor into the humerus.
- Evaluating Range of Motion: The surgeon checks the elbow throughout a full range of motion, confirming that the construct maintains appropriate, stable tension in full extension and at 90 degrees of flexion.
- Securing the Construct: To prevent "windshield wipering" (the fiber tapes wearing against the bone), the remaining stay stitches from the anchor are used to execute figure-of-eight sutures. This pulls the native LUCL tissue directly over the top of the fiber tape, blending the repaired ligament and the internal brace into a singular, highly robust construct.
Following the procedure, the patient is placed in an elbow splint for two weeks, after which they are cleared for free range of motion.
