Check out our new ACL Repair (Preservation) technique to help patients get back from ACL injury faster with better outcomes.

In this video, Dr. Grant H. Garcia demonstrates a modern joint-preservation procedure: an ACL Repair with an Internal Brace. Unlike a standard ACL reconstruction, which removes the torn ligament entirely and replaces it with a harvested tendon graft, this technique physically repairs the patient's native ligament. It is reserved for ideal candidates who suffer a proximal tear (torn right at the upper attachment to the thighbone) where the remaining body of the ACL tissue is healthy and high-quality.

Surgical Process Breakdown

• Notchplasty and Microfracture Conditioning: Dr. Garcia begins by performing a straightforward, minimal notchplasty (smoothing down a small piece of bone inside the knee joint). This maximizes visual clarity and allows him to safely clear away old scar tissue to expose the natural femoral footprint. He then uses a microfracture "power pick" tool to tap tiny holes directly into the femoral wall. This induces local bleeding to stimulate stem cell growth, which significantly improves the native ligament's ability to heal back onto the bone.
• Drilling and Suturing the Ligament: The surgeon utilizes a small spade-tip pin to drill a tunnel through the femoral side. Turning his attention to the resting ligament tissue, he uses an arthroscopic suture passer (Knee Scorpion) to pass specialized, heavy-duty suture loops (FiberRings) directly through the tissue. He places two separate, alternating tissue bites—one 35mm loop and one 25mm loop—carefully avoiding a bite that is too close to the frayed tear face where the tissue quality is weak.
• Integrating the Internal Brace and Tightrope System: The trailing ends of the FiberRings are threaded into an advanced adjustable suspensory fixation device (Tightrope 2 system). Alongside these sutures runs the internal brace—a thick, braided suture tape that will serve as a physical seatbelt for the knee. The tightrope device is slowly drawn up into the femoral tunnel until its low-profile button flips flat against the outside wall of the bone.
• Tensioning and Biomechanical Strength Testing: As Dr. Garcia pulls the tensioning lines on the tightrope, it draws the native ACL tissue upward, compressing the torn upper face firmly flush against the microfractured bone footprint. He holds tightly to the internal brace during this phase to keep the hardware perfectly aligned. The trailing tail of the internal brace is threaded directly down through the center of the ACL and out through a tibial tunnel to act as a parallel support column.
• Clinical Validation: To verify the construct before concluding, the surgeon cycles the knee through a range of motion to stretch out any slack. He performs a manual Lachman test and an anterior drawer test, confirming a complete return to optimal ligament tension.

By avoiding a full graft harvest and preserving the patient's natural nerve receptors (proprioception), this procedure offers a highly functional recovery. Biomechanical studies show this internal brace technique provides massive structural reinforcement, resulting in an exceptionally low re-tear rate of just 5% to 7%.