Check out Dr. Garcia’s new knotless MPFL Technique in 4K

This video, titled "Check out Dr. Garcia’s new knotless MPFL Technique in 4K," demonstrates an arthroscopic Medial Patellofemoral Ligament (MPFL) reconstruction using a fully knotless fixation technique. The procedure is performed on a patient experiencing recurrent patellar instability that has prevented a return to sports.

The surgeon utilizes a semitendinosus allograft (donor tissue) to reconstruct the ligament, which reduces patient comorbidities by avoiding a secondary hamstring harvest.

The primary surgical steps shown in the video are:

• Patellar Preparation: The surgeon makes a medially based incision and a small arthrotomy to directly view the cartilage surface. A rongeur is used to prepare the inner edge of the kneecap (patella), carving a small bone trough where the graft will eventually sit flush.
• Anchor Placement: Two small, hand-inserted knotless suture tacks are placed along the medial edge of the patella. The surgeon notes that care is taken during insertion to stay perfectly in line and avoid penetrating the nearby joint cartilage.
• Femoral Tunnel Location: Under fluoroscopic (X-ray) guidance, the surgeon identifies "Schöttle’s point"—the exact anatomical attachment site on the femur. A Cobb elevator is used to clear soft tissue, and finger palpation locates the adductor tubercle and medial epicondyle. A guide pin is inserted, a reamer maps the pathway to the opposite bone cortex, and an isometry check ensures the distance remains stable during knee movement.
• Graft Fixation to the Patella: The semitendinosus allograft is threaded into the knotless suture tacks. As the tacks are deployed, they tightly pull the graft down flush into the prepared bone groove, providing strong initial fixation without the bulk of tied knots.
• Tunneling and Graft Passage: The surgeon creates a pathway beneath the tissue layers (between the capsule and the vastus medialis) and pulls the graft limbs through to the femoral tunnel using a passing suture, ensuring the tissue does not twist.
• Femoral Tensioning: The graft limbs are drawn into the femoral tunnel. With the knee flexed between 35 and 45 degrees, the surgeon and a physician assistant check the isometry. A PEEK interference screw is driven into the femur to lock the graft in place. The surgeon checks that there are fewer than two quadrants of patellar pat mobility to ensure the joint is stable but not over-constrained.
• Capsular Closure: The surgeon scopes the knee to confirm the graft remains entirely outside the joint capsule (extra-articular). With the knee in full extension, a "pants-over-vest" overlapping tissue closure is performed using the remaining suture limbs to tighten the vastus medialis and capsule over the repair. The incisions are closed after a final range of motion check from 0 to 90 degrees verifies smooth tracking.