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Dr. Garcia demonstrates his technique for elbow UCL repair with an 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 an elbow medial ulnar collateral ligament (UCL) repair utilizing an internal brace, often referred to as a Tommy John repair with an internal brace.
Here is a summary of the procedure shown in the video:
- Initial Exposure and Visualization: The procedure begins on the medial side of the elbow. The surgeon splits the flexor fascia and performs a small ulnar nerve release inferiorly. A cobb elevator and a cricket retractor are used to achieve deep visualization and identify the partially torn UCL and the sublime tubercle.
- Addressing the Injury: Because the patient experienced a distal avulsion injury off the ulna, the surgeon begins the repair on the ulnar side. An arthrotomy is made in line with the UCL.
- Anchor Placement and UCL Repair: The surgeon drills, taps, and impacts a 3.75 SwiveLock anchor loaded with fiber tape and a 2.0 mini suture tape into the ulnar hole. Care is taken to visualize the articular surface to avoid penetration. The 2.0 suture tape is then used to repair and tighten the UCL back down. Throughout the retraction process, blunt retractors are used to protect the ulnar nerve.
- Humeral Fixation: The contralateral hole on the humeral insertion is marked out before losing visualization from the UCL repair. The surgeon marks the spot, drills, and taps for a 4.75 SwiveLock anchor.
- Tensioning the Internal Brace: To avoid over-tensioning, the arm is placed at roughly 45 degrees without specific stress, and a free needle is placed underneath the construct before the final anchor is dunked. The surgeon tests the range of motion to ensure the internal brace provides adequate tension without over-constraining the arm.
- Final Reinforcement: After securing the anchor, stay sutures are used to repair the internal brace to the deep UCL to prevent "windshield wiper" movement of the tapes. A final check confirms that the ulnar nerve is unaffected and that the overall construct is robust with full range of motion.
Dr. Garcia notes that this technique offers biomechanical strength similar to a traditional Tommy John reconstruction and serves as an excellent repair option for high-level pitchers.
