This video features orthopedic surgeon Dr. Anthony A. Romeo performing an Ulnar Collateral Ligament (UCL) Repair with an Internal Brace on a 21-year-old baseball pitcher.

This procedure serves as an alternative to traditional "Tommy John" surgery (full reconstruction) when the athlete's native ligament is generally healthy but has torn away directly from the bone-in this case, a humeral-sided avulsion injury.

The breakdown of the surgical technique and the recovery process are detailed below:

Surgical Workflow

1. Landmarking & Incision

Dr. Romeo marks out the anatomical landmarks-the medial epicondyle on the humerus and the sublime tubercle on the ulna. He makes a small incision over the front of the elbow, staying away from the ulnar nerve and skin nerves to avoid neuroma complications.

2. Muscle-Splitting Exposure

The surgeon utilizes a muscle-splitting approach through the flexor pronator mass. By separating rather than cutting the muscle fibers, he carefully exposes the underlying native UCL.

3. Inspecting & Preparing the Ligament

The native ligament is split open to check its structural integrity. The tissue shows a disorganized, fibrous pattern near the humerus where it was injured. The surgeon lightly debrides the area to clean up old scar tissue and stimulate fresh healing.

4. Proximal Anchor Placement

Because the patient's bone is incredibly hard, the surgeon drills and taps a pilot hole into the medial epicondyle. He then inserts a heavy-duty bone anchor pre-loaded with a repair suture and a collagen-coated fiber tape, which acts as the Internal Brace.

5. Native Ligament Repair

The arm is shifted into a varus position to take all the laxity and slack out of the joint. The surgeon uses the repair sutures to stitch the native ligament firmly back down to its original attachment point on the humerus.

6. Distal Anchor & Internal Brace Fixation

A second socket is drilled into the ulna, roughly one centimeter below the elbow joint line. The fiber tape is pulled taut over the repaired native ligament to provide immediate structural reinforcement and anchored into the ulnar bone.

7. Tissue Integration & Closure

The surgeon circumferentially stitches the native UCL and the synthetic fiber tape together, creating a unified, thick band of tissue to prevent shifting or snapping during early recovery. He tests the elbow's range of motion to ensure there is no catching before closing the fascial layer and skin.

Post-Operative Recovery & Rehabilitation

Dr. Romeo explains that repairing the native ligament with an internal brace cutting-edge technique slashes recovery time nearly in half compared to a full reconstruction.

• Week 1: The arm is placed in a hinged elbow brace locked strictly at 70 degrees for comfort and initial immobilization.
• Weeks 2–4: The brace is unlocked to allow full bending (flexion), but straight-arm extension is blocked at 20 degrees to protect the fresh repair from tearing under tension.
• Week 4: The brace is removed completely. The athlete begins formal physical therapy focusing on range of motion and baseline strengthening.
• Month 3: Treatment advances to sport-specific training, and the player is typically cleared to start a progressive, supervised interval throwing program.
• Months 6–9: Most pitchers are throwing well by 6 months and can achieve a full, competitive return to game play within 7 to 9 months.

Clinical Insight: Traditional Tommy John reconstruction routinely takes 12 to 15 months for a full competitive return. Because of this massive time savings, Dr. Romeo notes that this internal brace repair is now chosen for 75% to 80% of localized high school and college UCL tears.