Dr. Grant Garcia performs UCL Reconstruction with Hamstring Autograft

This video features Dr. Grant H. Garcia demonstrating an ulnar collateral ligament (UCL) reconstruction using a gracilis hamstring autograft. He highlights the advantages of his new knotless fixation technique over the traditional, more complex docking technique, which can be particularly challenging when handling thicker hamstring grafts.

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

• Dual-Surgeon Efficiency & Graft Harvest: To optimize surgical efficiency, a dual-surgeon approach is utilized. While Dr. Garcia's partner begins the ulnar nerve transposition, a standard hamstring harvest is executed simultaneously to obtain the patient's gracilis tendon autograft.
• Preparing the Ulnar Tunnel: The surgeon observes significant structural gapping and damage to the patient's native UCL. He identifies the isometric point at the sublime tubercle on the ulna, places a guide pin, and drills a socket to a depth of 15 millimeters using a 5.0mm reamer.
• Ulnar Graft Fixation: The gracilis graft—which is typically larger than a standard palmaris longus (PL) tendon—is loaded onto a 4.75mm fork-tip SwiveLock anchor along with a suture tape for the internal brace. The fork-tip anchor allows the thick hamstring graft to be driven seamlessly down into the socket, achieving strong initial fixation without the challenge of pulling or threading the tendon through narrow bone tunnels.
• Preparing the Humeral Tunnel: Turning to the upper arm, a guide pin is placed directly down the humeral column. A socket is reamed to a depth of roughly 20 millimeters. The surgeon drills slightly deeper here to accommodate a standard SwiveLock anchor and ensure the tendon has enough room to sit without bottoming out. A 5.5mm hand reamer is used to gently widen and chamfer the entry point to ensure a smooth transition for the thick graft.
• Tensioning and Humeral Insertion: With the elbow placed in the throwing position under slightly reduced force, the surgeon marks the graft to ensure 10 to 12 millimeters of tendon will sit securely within the socket. The graft limbs and internal brace are driven into the humerus using the standard SwiveLock anchor, compressing the graft into a tight press-fit.
• Stability & Range of Motion Testing: The surgeon systematically tests the elbow across its range of motion. The construct demonstrates excellent resistive force and tension in the throwing position. He verifies that the joint is not over-constrained in full extension, noting that hamstring reconstructions naturally present a perfect balance—becoming slightly tighter in flexion and slightly looser in extension.
• Final Reinforcement: To complete the procedure, the synthetic internal brace is securely sutured directly to the newly reconstructed gracilis graft using Vicryl stay sutures. This eliminates "windshield wiper" friction against the bone and merges the components into a single, cohesive unit.