Dr. Garcia demonstrates his technique for Patellofemoral replacement.

In this video, Dr. Grant H. Garcia demonstrates a patellofemoral replacement (or patellofemoral arthroplasty) procedure, which is a type of partial knee replacement focusing strictly on the kneecap and its groove.

The procedure follows these primary surgical stages:

• Diagnostic Arthroscopy: The doctor performs an initial arthroscopy to confirm that the medial and lateral compartments of the knee are healthy and free of defects.
• Patellar Preparation: A standard medial patellar incision is made. The patella is everted (flipped), measured using a caliper to ensure it is not cut too thin (leaving at least 12mm), and sequentially sawed down. Three guide holes are drilled to fit the new patellar button implant.
• Trochlear Groove Preparation: Dr. Garcia identifies anatomical landmarks (Whiteside's line and the epicondylar axis) to align an intramedullary guide system. A cutting guide is pinned in place to perform the anterior and trochlear cuts, carefully avoiding any bone notching.
• Trial & Alignment Checks: A sizing trial (size 2 in this case) is selected and pinned, ensuring it sits completely flush along the crucial lateral edge of the trochlea. The surgeon cleans up any remaining raw cartilage edges or osteophytes (bone spurs).
• Tracking Test: The knee is run through its range of motion. Dr. Garcia uses a towel clamp to temporarily close the joint capsule and tests the tracking with his finger to verify there is no catching, locking, or maltracking. A minor lateral release is performed to further optimize the kneecap's movement.
• Final Implantation: The joint is irrigated copiously and dried. Bone cement is applied to the femur and the trochlear component is impacted into place. Cement is then applied to the patella to secure the patellar button. All excess cement is cleared away before it hardens to complete the reconstruction.