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Dr. Garcia demonstrates his all suture technique for ACL repair and ACL tibial spine repair.
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.
In this surgical video, Dr. Grant Garcia demonstrates an advanced, all-suture arthroscopic repair technique for a complex, late-presentation ACL tibial spine fracture malunion, combined with a primary ACL repair.
Visualization and Management of Incarcerated Tissue
- Freeing the Meniscus: The procedure begins by managing the meniscofemoral ligament, which is found trapped (incarcerated) within the fracture site. A spinal needle is passed through the medial meniscus to deliver a PDS suture, which is used to tension and pull the meniscus clear of the fracture.
- Malunion Debridement: Because this patient presented late (four weeks post-injury), the tibial spine fracture fragment had already begun to heal in a poorly aligned, displaced position (malunion). Dr. Garcia uses sequencial shavers and elevators to elevate the displaced piece and meticulously clear out poorly healing tissue and bone.
- Preventing Impingement: The anterior portion of the displaced bone fragment is carefully removed. This is a critical step to prevent postoperative roof impingement and a loss of full knee extension. A shaver is used to debride non-union tissue and prepare a clean, vascular bony bed for the ACL footprint.
