This video features a real surgical demonstration performed by Dr. Anthony A. Romeo, illustrating an ulnar collateral ligament (UCL) repair with internal brace augmentation on a 16-year-old athlete.

Below is a detailed description of the surgical procedure and key components shown in the video:

• Patient Background & Indication: The patient is a young baseball player with a partial tear at the proximal portion of his ulnar collateral ligament (attached to the medial epicondyle). Because two full rounds of non-surgical, conservative treatment failed to improve his symptoms, surgery was chosen to restore elbow stability.
• Incision & Exposure: A standard incision is made over the medial epicondyle. Dr. Romeo utilizes a muscle-splitting technique through the flexor-pronator mass. This approach avoids disturbing or having to transpose the ulnar nerve, reducing the risk of nerve irritation.
• Identifying Landmarks: The surgeon exposes the sublime tubercle on the ulnar side and the medial epicondyle on the humeral side. These landmarks act as reference points for checking the precise location of the joint line and the native ligament.
• Proximal Anchor Placement: Because the tear is at the proximal end, an anchor loaded with both high-strength suture (FiberWire) and a flat collagen-coated tape (FiberTape) is placed into the humeral bone at the native attachment site.
• Suture Repair of the Ligament: Using a needle, the surgeon passes heavy sutures through the healthy tissue of the native ligament to anatomically pull the torn proximal fibers back down to the bone, closing the structural defect.
• Distal Internal Brace Fixation: The joint line is re-measured, and a pilot hole is drilled into the ulna roughly 1 cm below the joint line, angling away from the articular surface. The FiberTape spans across the joint to act as an "internal brace," protecting the ligament during healing. The tape is secured distally using a knotless anchor while keeping the arm in a slight varus position (ensuring proper tension without over-tightening).
• Final Assessment & Closure: Additional sutures are placed to weave the internal brace tape and native ligament together so they move seamlessly as a single unit. Dr. Romeo checks the elbow's range of motion from full extension to deep flexion to ensure there is no mechanical restriction or capturing. The surgical site is irrigated, and layered closure is performed on the fascia and skin.