So, UCL repair with internal brace. We're going to change the game entirely. Going back, I am a consultant for Arthrex and I receive a royalty on a kit. Tried and true, the gold standard. This is the UCL reconstructions, first done by Frank Jobe on Tommy John in 1974, modified by Andrews, 84 to 88 percent depending on what technique you use. They're all about the same, whether you use a hybrid or the Dane technique or docking, all of the success rates are in the high 80s, but it's a long recovery, 12 months. And a tendon graft, no matter where you put it, has to undergo ligamentization, so it's a process. And repair back in those days, Andrews did it and Jobe did it. They reported in the original articles by John Conway and Fred Azar, they were fellows at the time. They did some repairs and they didn't do very well. In fact, the failure rates in the repairs were 75 percent compared to 75 percent success with reconstruction. And so the two giants of our profession that ever did this operation on this planet basically said repair was a bad idea. And then I trained with Andrews and he told me again it was a bad idea. So over 40 years, the surgical and perioperative experience got bigger, the indications improved, we learned more about the anatomy, also the technology improved. And so our technology ability through super tapes and biologics and anchors and things they didn't have back in the 70s and 80s got better along with our understanding of the rehab to the point that obviously there's now even a code for it and we know in this country you don't get a code unless something actually works. So Arthrex said the tape won't fit through the islet and I said, let's find out. And they said, we're not sure this is going to work. And I said, let's try it in a cadaver. Let's do some basic science work. Let's do some pullout tests. Let's do some range of motion tests. Let's do some cyclical tests to see if we can rehab these people quicker. And then Arthrex said, this is going to replace reconstruction. And I said, wait a minute. It'll replace it for some, but not all. And that was the whole point. So our first patient was coming up on 10 years ago. I can't believe it's been 10 years. We've done over 700 of them in Birmingham as of last week and over 7,500, this is an Arthrex estimate nationwide. And many busy UCL surgeons have incorporated this into their practice. In 2017, less than 10% of UCL surgeries in the NCAA were done with repair. In 2019, it was up to 25%. We expect it to be somewhere around 50% this year. Less time, less surgery, less recovery, and more success. So this is kind of a short list that's incomplete, obviously, of the who's who of elbow docs. And I want to say a special thank you to Buddy, because he was there with me the whole time. You can see his name on there. He guided me on this. But this is a who's who list of some of the best elbow docs in the country. And this has been one of the most rewarding part of it. So aside from the patients that I've had the pleasure to treat, and the widespread acceptance of the technique, seeing my colleagues that take care of these problems adopt this technique in their clinics and in their operating rooms, and to think that a simple idea repurposing some things and some new technology would make this much of an impact is a little bit humbling. To the point that even Jim Andrews is now sending me patients. He's at 81, he said, I'm not learning to do something new. But he's even sending me these people. So there's mostly baseball, but some softball, volleyball, basketball. The average return time is about six months, which is half of the return time from reconstruction. And some gymnasts and other sports are getting back in less time than that. I think you're going to see Brock Purdy on the sidelines with the San Francisco 49ers here in the not so distant future. So I have a quick video. This is a girl that got back to level 10 gymnastics, and she actually is competing to be part of Team USA following a reconstruction on one of those arms. Athletes of all parts, colors, sizes, and everything else are getting better with these things. So this is the last one. Rich Hill, and I have his permission to say this, Rich at the time was a 39-year-old Major League pitcher, got hurt in September of 19, surgery in October of 19, went back to Major League in June of 20 during COVID. He was Major League Pitcher of the Month in May of 21. And believe it or not, at age 43, he is still a starting pitcher at Major League Baseball. It's hard to come back as a starter after this thing. And hopefully this is going to play. Let's see if we can get this to play. Dr. Dugas Rich Hill at the Tampa Bay Rays. This is when he was with the Rays. I'd like to congratulate you on your nomination for innovation. I would not be here continuing my career at the highest level at age 41 if it wasn't for your creativity and innovative mind to come up with the internal brace for the UCL and be able to benefit from this great surgery. I'd like to wish you all the best and congratulations again. Many thanks to my man Rich Hill. Pretty average testimonial. Questions? Dugas, internal braces everywhere in the body. Where did that originate? It started in the foot and ankle with a guy named Gordon McKay, who's a Scottish foot and ankle surgeon. And if you've ever spent time with Gordon, not only is he one of the most entertaining people on the planet, but he's also a phenomenal surgeon and has taught us a ton. And we actually, he's starting an internal brace society from that. So he's a wonderfully good guy and he drinks a lot of whiskey, which is, we can talk about that too. Yeah, Mark. So did you come up with the idea of putting it in the eyelid or did McKay already figure that out? McKay already figured that out, but I was the one that came up with the idea of doing it in the elbow and then adding the suture and the tensionable type of way of doing it. He had done it with a fixed anchor and then an eyelid anchor. I did it with both eyelid anchors and then added the suture. And also we use the collagen here in Europe, they don't use the collagen dip because they're not allowed to, but we use the collagen dipped tape, which I also think makes a big difference. And interestingly, we haven't seen the tape rupture. That's not the failure mode. And we see UCL reconstructions fail, you know, three, 4%, which is very low. And it's still, like I said, the gold standard. But the UCL repair with the internal brace, the failure mode is not the tape breaking. There are other failure modes, but it's really not structural. It's pain, it's nerve, you know, irritation, it's things like that, but not so much the tape tearing. And we really haven't seen that very often. Last question. Mark. Yeah, I have an N of 1. Questions of histology. Is there histology? I have an N of 1. And it was a case that Chris Ahmad and I both operated on. I did his repair with internal brace. He developed heterotopic bone. I went back and took that out. He redeveloped it. I sent him to Chris because I wanted another pair of eyes. We both agreed to revise it to reconstruction. So Chris did the reconstruction, and we took some tissue, Chris took some tissue, and the tape was completely incorporated into this collagenous fibrous. And it looks, when you look at it, it's appealing to look at. That doesn't mean anything, but it was collagenous, you know, organized longitudinal fibers. Great, Jeff. Thank you.

UCL repair with internal brace

orthopedic surgery

recovery time

success rates

Gordon McKay