Dr. Garcia demonstrates his technique for combined ACL reconstruction with a medial meniscus transplant.

In this video, Dr. Grant H. Garcia demonstrates a complex, salvage procedure combining a Revision ACL Reconstruction with a Medial Meniscus Transplant. This specific patient had undergone three previous failed ACL surgeries by other surgeons and required comprehensive bone grafting six months prior to completely heal and fill out massive, old bone tunnels before this reconstruction could take place.

The comprehensive procedure follows these key steps:

• Joint Debridement and Bed Preparation: The surgeon shaves down the damaged native tissue, leaving a stable 1 to 2-millimeter rim of the old meniscus to anchor the new transplant. He also performs a small posterior-medial notchplasty (shaving a tiny piece of the femoral bone) to open up clear visualization of the posterior root attachment site.
• Femoral and Tibial Tunnel Drilling: Dr. Garcia drills the new femoral tunnel to a depth of 25mm using an anteromedial portal and a protective reamer. Next, utilizing an arthroscopic guide system and a specialized flip-cutter, he creates a 9mm socket directly into the posterior meniscal root attachment point. A main tibial tunnel is then drilled for the ACL graft, taking immense care to bypass and protect the newly drilled meniscal root socket.
• Suture Shuttling and Management: To manage a high volume of lines without tangling, a clear plastic passport cannula is inserted. The surgeon shuttles high-strength nitinol wire loops and passing sutures through the portals, checking them methodically before introducing the graft.
• Meniscal Transplant Insertion and Seating: The donor medial meniscus allograft is introduced into the knee. The attached posterior bone plug is guided carefully down into its matching bone socket. Once the plug is securely "dunked" into place, the surgeon places two robust, all-inside suture devices to compress and anchor the posterior horn of the transplant securely against the joint capsule.
• Peripheral Stabilization: Using a zone-specific cannula system, Dr. Garcia places 4 to 5 superior vertical mattress stitches around the periphery, alongside multiple inferior stitches. This specific pattern creates an incredibly strong biomechanical construct that pulls the meniscus tight against the capsule wall. The anterior horn and its corresponding bone plug are securely fixed at the front of the knee through a small mini-open incision.
• ACL Graft Fixation & Final Tensioning: With the meniscus fully anchored, the surgeon switches focus back to the ACL graft (a bone-tendon-bone allograft). The femoral bone plug is pulled into its socket and locked tight using a PEEK interference screw, chosen for its MRI compatibility so future scans can check on the meniscus transplant cleanly. Finally, the tibial side of the ACL is fixed, a Lachman test confirms rigid knee stability, and the remaining peripheral meniscal sutures are tied down securely while holding the knee in full extension.