Dr. Garcia demonstrates his technique for cartilage transplants for the treatment of knee OCDs.

In this video, Dr. Grant H. Garcia demonstrates his surgical technique for an osteochondral allograft transplantation (cartilage transplant) to treat a large Osteochondritis Dissecans (OCD) lesion in the knee. In this specific case, the cartilage defect is accompanied by a meniscus transplant, but the focus of this clip is entirely on the meticulous shaping and press-fitting of the donor bone-and-cartilage plug.

The step-by-step surgical description includes:

• Surgical Exposure and Joint Evaluation: The surgeon performs a medial arthrotomy (open incision on the inner side of the knee) and retracts the patellar tendon and newly transplanted meniscus to gain clear exposure to the femoral condyle. He reveals a large, deep OCD lesion where the native cartilage and underlying bone have completely worn away.
• Recipient Bed Preparation: Dr. Garcia measures the exact diameter of the lesion to choose the right sizing tools. He inserts a central pin guide and uses a specialized reaming system to cut a clean, circular socket out of the damaged bone. The socket is reamed to a depth of 5 to 9 millimeters—the ideal depth window to encourage seamless integration between donor and native bone.
• Harvesting the Donor Core: Switching to the healthy donor bone segment, the surgeon clamps down a matching guide holder (a 20mm socket size in this case) and matches the precise curvature of the patient's joint. He copiously irrigates the area with water to protect the living cartilage cells from heat while coring out an identical cylindrical bone plug.
• Sizing and Trimming the Allograft: The harvested donor plug is extracted, and the surgeon methodically measures the bone depth at four distinct time points—the 12, 3, 6, and 9 o'clock positions—marking them to perfectly match corresponding depth marks made in the patient's knee socket. A specialized saw trims away any excess bone thickness.
• The Waffle Cut and Edge Beveling: To make sure the plug doesn't sit "proud" (raised above the surrounding surface), the surgeon scores the bottom of the donor bone with a series of minor saw incisions known as a waffle cut. This gives the bone a tiny bit of structural compression during insertion. He then gently shaves down and bevels the circular edges to help the plug slide into the socket easily.
• Seating and Press-Fitting: The graft is thoroughly washed to clear away old donor marrow elements and soaked in healing biologics (like PRP or bone marrow aspirate). Aligning the 12 o'clock indicators perfectly, the plug is pushed into the knee bed. The surgeon finishes seating it with a specialized impactor block designed to bridge half on the native tissue and half on the donor graft, ensuring it is driven perfectly flush.
• Final Inspection: Any tiny overlapping tissue edges are neatly sculpted away with a scalpel. The surgeon then moves the knee joint through its natural range of motion to ensure the new cartilage surface feels seamless, tracks smoothly, and exhibits no catching or locking.