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Complex surgeries are sometimes needed. Check out our most recent video showing a combined MACI.....
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 "MPFL, MACI, TTO with Distalization," demonstrates a complex knee surgery combining a Medial Patellofemoral Ligament (MPFL) reconstruction, Matrix-Induced Autologous Chondrocyte Implantation (MACI) of the patella, and a Tibial Tubercle Osteotomy (TTO) with distalization.
The procedure shown includes:
- Initial Exposure: Making a central incision, exposing the planes on the medial and lateral sides, and isolating the patellar tendon.
- Tibial Tubercle Osteotomy (TTO): Using an alignment guide and an angled saw to perform a diamond cut on the tibial tubercle, allowing it to be mobilized for distalization (moving it downward).
- Lateral Retinacular Release: Performing a lengthening procedure to reduce tension on the lateral facet.
- MACI Implantation: Preparing a large lateral facet cartilage defect on the patella, grafting a small bone cyst using autograft from the tubercle, and carefully cutting and placing the cell-seeded MACI implant using TISSEEL to secure it.
- Tubercle Fixation: Moving the tubercle down by one centimeter (distalization) along with medialization and anteriorization, then securing it firmly with cannulated screws.
- MPFL Reconstruction: Using knotless fiber-tak anchors on the medial side of the patella to cinch down a semitendinosus allograft, passing it through a femoral tunnel, checking isometry, and securing it with a peak screw to correct patellar tracking.
