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Check out Dr. Garcia’s technique for MCL reconstruction
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, titled "Check out Dr. Garcia’s technique for MCL reconstruction," demonstrates a Medial Collateral Ligament (MCL) reconstruction using an Achilles tendon allograft (donor tissue). The procedure is performed on a patient exhibiting severe inner knee instability and gapping on both physical exam and arthroscopic evaluation.
The primary surgical steps shown in the video include:
- Femoral Isometric Point: The surgeon uses intraoperative X-ray to locate the precise isometric attachment point on the femur (the point where tissue tension remains steady through knee movement). A wire is placed, followed by a 9-10mm reamer, to map out a bone socket roughly 20-30 millimeters deep.
- Graft Tunneling: The fan-shaped Achilles allograft is prepped on the back table. A subcutaneous tunnel is created superficial to the native, torn, and loose MCL tissue, bridging the femoral site to the shinbone (tibia).
- Deep vs. Superficial Placement: To anatomically recreate both the deep and superficial layers of the MCL, a small 4.75mm bone anchor is positioned about 1 centimeter below the joint line on the tibia to manage the deep attachment.
- Femoral Fixation: A passing stitch pulls the graft into the femoral socket. The surgeon maintains steady tension from both ends to ensure the graft stays flat and un-twisted, locking it tightly into the femur with a specialized PEEK interference screw. An isometry check is performed at 20 degrees of knee flexion.
- Tibial Footprint Preparation: The surgeon marks out a 6-centimeter target down the tibia from the joint line to mimic the natural MCL attachment footprint. The graft tissue is split into two distinct bundles/limbs. Suture tapes are threaded down and back through the tissue using a locking Krakow stitch.
- Tibial Fixation and Tensioning: With the leg bent at 20 degrees and a firm corrective force applied to the knee, the surgeon drives a SwivelLock anchor into the tibia to secure the primary limb under tension. A second SwivelLock is placed slightly more to the front (anterior) to attach the second limb, completing the two-bundle anatomic reconstruction.
- Final Checks: The deep tissue sutures from the first anchor are tied over the reconstruction using a horizontal mattress pattern. The surgeon finishes by scoping the joint one last time to visually verify that the abnormal knee gapping has been fully reduced and the joint is stable.
