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Dr. Garcia demonstrates his technique for tibial tubercle osteotomy for patella realignment and cartilage procedures.
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 a tibial tubercle osteotomy (TTO) procedure, performed here in combination with MACI (cartilage treatment) and an MPFL reconstruction to correct patellar alignment and stability.
The surgical technique follows these key steps:
- Exposure and Soft Tissue Elevation: Both sides of the patellar tendon are carefully identified to prevent accidental damage. The surgeon uses a Bovie cautery tool to elevate the periosteum over the lateral compartment and a series of surgical elevators to place a retractor behind the lateral side of the tibia. This retractor protects the deep neurovascular structures during bone cuts.
- Pin and Guide Alignment: An Arthrex centering pin is placed parallel and perpendicular to the bone. Dr. Garcia then mounts a specialized 45-degree guide system, firing sequential pins to hold the template firmly just medial to the patellar tendon.
- The Osteotomy (Bone Cutting): Using a specialized saw with continuous irrigation to prevent thermal bone damage, a diamond-shaped cut is made down the shinbone. This diamond shape provides a massive surface area for reliable healing. The surgeon combines vertical and horizontal saw passes, making sure to leave a precise distal hinge at the bottom of the cut.
- Shifting the Tubercle: An osteotome (bone chisel) is carefully tapped into the cut to hinge open the tubercle segment. This allows the surgeon to physically shift the bone fragment slightly forward (anteriorization) and inward (medialization) to optimize the tracking of the kneecap.
- Rigid Internal Fixation: To lock the shifted bone fragment into its new position, the surgeon drills bicortically (through both outer layers of bone) and sets 4.5mm cannulated lag screws. He checks screw lengths, countersinks the holes so the screw heads sit low-profile, and drives them home from a lateral-to-medial direction. A temporary, out-of-plane pin is used to compress the bone during screw insertion and prevent the fragment from fracturing.
- Contouring and Testing: Once the screws are fully tightened, the knee is cycled through a range of motion to test the stability of the reconstruction under immediate load. Finally, Dr. Garcia uses a rongeur to trim down any sharp, prominent bone edges on the medial side to prevent the hardware from irritating the patient's skin or soft tissues post-surgery.
