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Dr. Garcia demonstrates his technique for IT band tenodesis. This method reduces retears in revision ACL surgery.
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 video, Dr. Grant H. Garcia demonstrates his surgical technique for an Iliotibial (IT) Band Tenodesis (specifically, a modified Lemaire extra-articular tenodesis). This procedure is performed on the outside of the knee alongside an ACL reconstruction to help stabilize patients with a high-grade "pivot shift" (rotational instability) or those undergoing a revision ACL surgery. Dr. Garcia notes that adding this procedure can decrease ACL re-rupture rates by 5% to 7% in revision cases.
The step-by-step surgical description includes:
- Surgical Exposure & Strip Harvesting: The surgeon makes a skin incision on the outside of the knee, positioned between Gerdy’s tubercle (on the upper tibia) and the lateral epicondyle (on the femur). Centered directly over the lateral collateral ligament (LCL), he harvests a 1.5-centimeter-wide strip of the IT band tendon, leaving its base naturally attached down at Gerdy’s tubercle while releasing the top portion proximally.
- LCL Tunnel Preparation: The surgeon isolates the LCL. To run the harvested IT band strip underneath it without weakening the ligament, he makes two small vertical slits directly along the LCL fiber path. A curved snap instrument is passed through to open up a safe corridor under the ligament.
- Femoral Socket Creation: A guide pin is placed just proximal and posterior to the lateral femoral epicondyle. A socket is then reamed into the femur to a depth of 20 to 25 millimeters to ensure there is enough bone-to-tendon contact area for a secure fit.
- Weaving & Passing the Graft: The free end of the IT band strip is prepared and reinforced using a high-strength suture tape loop, and any frayed edges are neatly debrided. The graft is then pulled underneath the LCL using a pull-through technique toward the femoral socket. (Note: Dr. Garcia emphasizes that this external tracking is established before the internal ACL graft is pulled through).
- Tensioning and Fixation: The knee is held at roughly 45 degrees of flexion with the foot in a neutral or slightly externally rotated position. The IT band strip is pulled firmly into the femoral socket to remove all slack, functioning as a structural replacement for the damaged anterolateral ligament (ALL) complex.
- Final Inspection: A PEEK interference screw is twisted into the femoral socket to anchor the tendon tightly against the bone. Finally, the surgeon moves the knee through a full range of motion to ensure the graft stays flush, checks that it successfully eliminates abnormal rotational play, and verifies that it does not over-constrain the joint during full extension (where the graft is naturally at its tightest).
