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Advancements in Quad ACL Reconstruction: Speed Closure Technique
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, presented by orthopedic surgeon Dr. Grant H. Garcia, provides a medical demonstration of a "speed closure" technique used to repair the quadriceps tendon defect immediately after harvesting a graft for ACL reconstruction.
The procedure is performed right after the quad tendon is harvested and before the arthroscopic part of the ACL surgery begins. The main objective is to efficiently and securely close the gap left in the quadriceps muscle and tendon tissue.
Key Aspects of the Procedure:
- Pre-Linked Suture: The surgeon utilizes a pre-linked suture that allows the repair to start without needing an initial knot. It is placed on both sides of the tissue defect and inverted to pull the quadriceps edges together.
- Running, Locking Technique: Using a specialized tool called a shoulder scorpion, the surgeon applies a rapid running, locking stitch (passing sequentially up and down). The locking mechanism is critical because it maintains constant tension and prevents any loose slack from developing in the repair line. This can be done via a mini-open incision or an even smaller horizontal incision using arthroscopic assistance.
- Burying the Knot: Once the repair reaches near the patella (kneecap), the suture is secured using alternating half-hitches. A final inverted pass is performed to bury the surgical knot deep inside the quadriceps tissue.
By burying the knot and utilizing a flat running stitch, the entire repair lies completely flush with the surrounding anatomy, eliminating bulky, palpable knots and reducing overall tissue prominence after surgery.
