Dr. Garcia's updated UCL reconstruction with internal brace

This technique highlights an updated, highly structured method for treating severe ulnar collateral ligament (UCL) injuries in overhead athletes. By combining an absolute structural graft with an internal brace, this hybrid reconstruction workflow delivers powerful initial stability and allows for a faster, reproducible setup.

The procedure focuses on several critical surgical transitions:

• Dual-Surgent Exposure and Graft Harvest: The procedure commonly starts with a dual-surgeon approach to maximize operating room efficiency. While one surgeon exposes the medial elbow and addresses any necessary ulnar nerve transpositions, the autograft (typically a hamstring tendon like the gracilis or semitendinosus) is simultaneously harvested.
• Ulnar Bone Bed Preparation: The surgeon clears the damaged native tissue and locates the isometric point at the sublime tubercle on the ulna. A small guide pin is placed, and a bone socket is drilled (typically to a depth of 15 millimeters) to create an ideal environment for the graft to sit.
• The "Double Dunking" Knotless Technique: Rather than using the traditional, highly complex docking method where tendons must be meticulously threaded through complex intersecting bone tunnels, an updated knotless anchor system is used. The thick hamstring graft is combined with a high-strength synthetic suture tape (the internal brace) and driven directly down into the ulnar socket using a fork-tip SwiveLock anchor, securing it smoothly into place.
• Humeral Anchor Fixation: A guide pin is directed carefully down the humeral column, and a corresponding bone socket is reamed (usually around 20 millimeters deep to ensure the graft has enough clearance and doesn't "bottom out"). The entry point is lightly hand-reamed and chamfered to prevent any friction or sharp edges from wearing down the graft.

Dr. Garcia emphasizes that this updated tensioning button makes the final fixation step substantially easier. Because the implant securely self-locks the tendon down into the bone bed as you pull, it eliminates the high-friction struggle of manually holding tension while tying knots, resulting in an exceptionally strong, rigid repair.