Dr. Garcia demonstrates is innovative technique for UCL (Tommy John) repair with Internal...

This video features Dr. Grant H. Garcia demonstrating his innovative technique for an ulnar collateral ligament (UCL) repair with an internal brace (Tommy John repair), combined with an ulnar nerve transposition for a patient experiencing throwing-related nerve symptoms.

Here is a summary of the procedure shown in the video:

• Exposure and Nerve Protection: The procedure begins with a standard medial-based incision, extended slightly more proximally to accommodate the nerve transposition. The surgeon carefully identifies and protects the medial antebrachial cutaneous nerve to prevent forearm numbness.
• Ulnar Nerve Release: The ulnar nerve is identified just inferior to the flexor muscle wad. The surgeon frees the nerve proximally and distally, releasing ligamentous attachments down toward the flexor carpi ulnaris (FCU) to allow the nerve to safely shift (sublux) anteriorly without tension.
• Joint Exposure and Debridement: The flexor wad is split at the first stripe using a fish-mouth incision. The surgeon uses a cobb elevator to separate the flexor wad from the UCL. Because this patient suffered a proximal avulsion (torn off the humerus), a split is made in the UCL to view the joint line. A small traction osteophyte on the ulna—common in high-level pitchers—is cleared off with a rongeur, and a curette is used to irritate the proximal footprint to stimulate a natural healing response.
• Humeral Anchor and UCL Repair: The sublime tubercle (on the ulna) is marked out early to prevent joint penetration after the tissue is closed. The surgeon drills, taps, and places a 3.5 SwiveLock anchor loaded with mini suture tapes and fiber tape into the humerus. Using a free needle, the mini suture tape is passed through the native UCL in a figure-of-eight fashion across at least three passes. The tissue is then pulled down and secured tightly at roughly 45 degrees using alternating half-hitch knots.
• Distal Anchor and Tensioning: A slightly larger hole is drilled and tapped at the sublime tubercle on the ulna. To avoid over-constraining the elbow joint, the insertion depth is marked directly on the fiber tape. With the arm at 45 degrees, a small freer elevator is placed under the fiber tapes to preserve a minor amount of slack. The distal 3.5 SwiveLock anchor is then inserted, and the surgeon tests the range of motion from zero to 90 degrees to verify stable tension without restriction.
• Preventing Windshield Wipering: To prevent the synthetic internal brace from wearing against the bone, the remaining stay stitches are woven through the native UCL tissue in two figure-of-eight patterns. This overlays the native tissue directly on top of the fiber tape. The flexor fascia is then closed using inverted knots to prevent skin irritation.
• Ulnar Nerve Transposition: Finally, the surgeon shifts their focus back to the ulnar nerve transposition. A subcutaneous flap is constructed out of superficial soft tissue. The nerve is kept moved forward (anteriorly subluxed) and protected using two to three figure-of-eight stitches to create a secure pocket.

The procedure concludes with a final range of motion test from zero to 90 degrees to guarantee there is no residual tension or binding on the newly positioned ulnar nerve.