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UCL reconstruction after previous UCL surgery
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 a revision ulnar collateral ligament (UCL) reconstruction on a high-level baseball pitcher. The patient had previously undergone a UCL repair with an internal brace that unfortunately failed, necessitating this slightly uncommon revision surgery.
Here is a summary of the procedure shown in the video:
- Pre-operative Instability Check: The surgeon begins by performing a stress examination on the elbow in the throwing position, which clearly demonstrates structural gapping and ligamentous laxity.
- Overcoming Prior Hardware: A major highlight of this specific revision technique is the ability to drill directly through the old, existing bone anchors. This eliminates the need for complex bone-grafting or worrying about compromised bone tunnels from the previous operation.
- Graft Preparation and Distal Fixation: The surgeon prepares a palmaris longus (PL) tendon autograft. The graft is secured distally into the sublime tubercle of the ulna using a fork-tip SwiveLock anchor.
- Humeral Fixation and Tensioning: With the elbow positioned at 45 degrees of flexion, the graft is brought proximally and dunked into the humerus using a second SwiveLock anchor alongside a new internal brace.
- Isometry and Stability Testing: The surgeon checks the construct for optimal isometry and confirms that there is zero joint gapping or movement under stress. The remaining native tissue is tied directly into the graft to reinforce the repair and prevent "windshield wiper" abrasion.
- Ulnar Nerve Revision: Because the patient had an ulnar nerve procedure during the first surgery, a revision ulnar nerve transposition is also performed to ensure the nerve is fully freed, stable, and untethered.
Dr. Garcia notes that despite the complexity of revising a previous repair, this streamlined workflow allows the core UCL reconstruction portion of the case to be completed in 45 minutes or less, giving the pitcher an excellent chance to safely return to throwing.
