Dr. Garcia demonstrates his new cutting edge technique for IT band tenodesis.

In this video, Dr. Grant H. Garcia demonstrates a specialized knee stabilization procedure detailing an Iliotibial (IT) Band Tenodesis using an advanced knotless fixation technique.

This lateral extra-articular procedure is primarily utilized in revision ACL surgeries or for patients presenting with a "high-grade pivot shift"—a severe rotational instability of the knee. The technique essentially reconstructs the function of the anterolateral ligament (ALL) to control abnormal internal rotation and help protect a primary or reconstructed ACL from failing.

Key Surgical Steps

• Incision and Mapping: Dr. Garcia makes a small, minimally invasive 5-centimeter incision centered directly over the lateral epicondyle of the femur. He physically maps out the anatomy, tracing the path down to the fibula to easily locate the surrounding ligaments.
• Harvesting the IT Band Strip: The surgeon isolates a small strip of the IT band tissue, measuring roughly 1 to 1.5 centimeters in width. He extends this strip down toward its natural attachment at Gerdy’s tubercle. Because of the specialized knotless fixation hardware used, a much smaller, thinner strip of tendon is required compared to traditional methods, keeping the harvest highly minimally invasive.
• Routing the Graft: After clearing away any scarred soft tissue on the undersurface, the harvested IT band strip is carefully threaded underneath the native Lateral Collateral Ligament (LCL).
• Placing the Knotless Anchor: Dr. Garcia identifies the precise anatomical origin of the ALL (roughly 3mm proximal and 1mm posterior to the lateral epicondyle). He drills and places a small, self-punching knotless anchor into the bone. This specific all-suture anchor compacts down to a tiny 5-millimeter footprint inside the bone. This is a massive advantage in complex or revision knee surgeries because it leaves plenty of room for drilling other tunnels (like an ACL tunnel) without the risk of overlapping or hitting bulky metal hardware.
• Tensioning and Securing: After whipstitching the end of the IT band strip, the surgeon hooks it into the loop of the knotless anchor, essentially using the mechanism like a low-profile synthetic staple. Before locking it down completely, the patient's leg is placed at 45 degrees of flexion. Cinched down in this position, the graft provides robust rotational tension to eliminate the knee's pivot shift.
• Final Reinforcement: To ensure the graft can never pull out, the trailing suture tapes are tied down on the opposite side of the LCL. Dr. Garcia places two or three "figure-of-eight" structural sutures to securely compress the folded IT band against the bone, concluding a very fast, high-strength reconstruction.