Dr. Garcia demonstrates his technique for patella tendon repair.

In this video, Dr. Grant H. Garcia demonstrates his advanced surgical technique for a Patellar Tendon Repair (a method he notes is highly similar to how he approaches quadriceps tendon repairs). The patient is an active individual who ruptured their tendon during a skiing injury. The video showcases how a complete rupture is reattached securely back to the bone using suture anchors and an anatomical tensioning method.

Surgical Process Breakdown

• Exposing and Debriding the Injury: The surgeon begins with a midline dissection over the front of the knee. The injury is identified as a clean proximal avulsion—meaning the patellar tendon has torn completely away from the bottom tip of the kneecap (patella), leaving a highly visible gap. Dr. Garcia cleans off the scarred tissue on the bone face of the patella and trims the torn end of the tendon to clear a fresh, healthy pathway for healing. He mobilizes the tendon by carefully separating it from the surrounding paratenon and fat pad.
• Placing Biocomposite Anchors: To establish an ultra-strong foundation on the bone, Dr. Garcia inserts three separate 4.75mm biocomposite corkscrew anchors directly into the lower margin of the kneecap. He positions these anchors in an inverted triangle formation, starting with one right in the center, followed by one on the inner (medial) side and one on the outer (lateral) side. These are sliding anchors loaded with high-strength suture tape.
• Whipstitching the Tendon (Krakow Method): The surgeon weaves the heavy suture tapes down through the disconnected body of the patellar tendon. For the medial and lateral lines, he executes a meticulous Krakow stitch (a interlocking locking loop stitch) traveling roughly two to three centimeters down the tendon and then looping right back up. He repeats a similar pattern for the central lines, practicing careful suture management so the needles never accidentally pierce or fray the adjacent strands.
• Tension-Slide Reduction and Knotting: To physically bring the dropped tendon back up to the kneecap, the opposite "sliding" strand from each anchor is passed a single time right through the insertion footprint. The surgeon places the patient's leg into a straight position (hyperextension) to maximize tissue mobility. He uses a tension-slide technique, pulling the lines to glide the tendon upward and compressing it tightly flush against the prepared bone face. The knots are then tied securely on top of the tendon.
• Retinaculum Repair and Stability Check: Because the anchors are double-loaded, Dr. Garcia saves the second set of remaining suture tapes to stitch together the torn medial and lateral knee retinaculum (the structural side tissues of the kneecap). This provides a complete, over-the-top soft tissue closure. To conclude the operation, he physically bends the knee up to 90 degrees of flexion under direct visualization. He checks for any widening or "gapping" at the repair site; seeing zero gap confirms a rock-solid construct that can safely transition into rehabilitation.