Dr. Garcia demonstrates his new innovative technique for MPFL reconstruction.

In this video, Dr. Grant H. Garcia demonstrates an updated surgical technique for an MPFL (Medial Patellofemoral Ligament) Reconstruction to treat chronic patellar instability and recurring kneecap dislocations. This approach stands out because it utilizes advanced knotless suture anchor technology directly on the patella, making the repair incredibly low-profile and strong.

The surgical procedure consists of the following phases:

• Patellar Exposure and Landmark Selection: The surgeon creates a small incision over the inner side of the knee to expose the medial border of the patella. He clears a small, neat groove into the bone and uses a pointed tip tool to mark two landmarks, ensuring the placement sits squarely on the upper half of the kneecap where the natural ligament attaches.
• Deploying Knotless FiberTack Anchors: While an assistant tightly stabilizes the kneecap to keep it from shifting, Dr. Garcia mallets two 2.6mm knotless FiberTack anchors into the marked bone sites, spacing them roughly one centimeter apart. He pulls firmly back on the lines to engage the hidden all-suture locking mechanisms inside the bone.
• Femoral Tunnel Alignment and Reaming: Using a mini C-arm X-ray system for visual guidance, the surgeon identifies Schöttle’s point (the natural femoral insertion site for the MPFL) with a guide pin. He drills a socket to match the width of the semitendinosus tendon allograft, reaming all the way up to—but not completely through—the far side of the femur. This provides a deep 21 to 23mm tunnel to prevent the graft from bottoming out.
• Shuttling and Locking the Graft: A tunnel tunnel corridor is cleared between soft tissue layers one and two on the side of the knee. The surgeon wraps the center of the tendon graft around the loop of the first patellar anchor and pulls the shuttle stitch through to cinch it tight. He repeats this for the second anchor, achieving an exceptionally tight, smooth, and knotless connection along the bone face. The leftover suture tails are set aside to repair the VMO (vastus medialis obliquus) muscle later.
• Tunnel Delivery and Interference Fixation: The free tails of the tendon graft are woven together and shuttled across the soft tissue corridor into the femoral tunnel. To lock everything down permanently, the leg is held at roughly 45 degrees of flexion—the precise angle where the kneecap naturally engages with its anatomical resting groove. A PEEK interference screw is then driven into the femoral socket to wedge the graft tightly against the bone.
• Checking Isometry: To wrap up, the surgeon carefully tests the movement of the knee. He confirms that the patella moves normally with less than two quadrants of outward play in full extension, verifying that the new ligament successfully secures the joint without being over-tensioned.