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Dr. Garcia demonstrates a custom patellofemoral replacement
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 features Dr. Garcia demonstrating a custom patellofemoral replacement on a relatively young patient presenting with severe trochlear dysplasia (abnormal groove shape) and severe patellofemoral arthritis.
The surgical procedure involves the following steps:
- Pre-Planning and Alignment: Because the procedure utilizes a custom-designed implant planned ahead of time via a 3D CT scan, standard on-the-fly alignment checks are not required. The surgeon secures a custom 3D-printed cutting guide to the femur using two pins.
- Surface Preparation: After marking around the edges of the cutting guide, the guide and pins are removed to reveal the exact footprint for the custom implant. The surgeon uses a curette to remove any remaining damaged cartilage down to the bare bone, creating an optimal surface contour for the implant without cutting away healthy bone.
- Drilling and Trials: The tracking pins are placed back in, and three precisely oriented holes are drilled into the bone to accommodate the implant's pegs.
- Addressing Concurrent Issues: Due to severe structural instability, the custom replacement is paired with a tibial tubercle osteotomy (TTO) and a medial patellofemoral ligament (MPFL) reconstruction to optimize patellar tracking.
- Final Evaluation: Once the custom patellofemoral implant, TTO, and MPFL grafts are securely set, the surgeon runs the knee through a range of motion. The video highlights excellent, stable tracking of the patella through the custom-fit trochlear groove.
