Dr. Garcia demonstrates his trochleoplasty technique

This video, presented by orthopedic surgeon Dr. Grant H. Garcia, provides a clinical demonstration of an open trochleoplasty technique on a young patient with severe trochlear dysplasia (an abnormally flat groove at the front of the knee) and an associated cartilage defect.

Because the patella (kneecap) was dislocating even at 90 degrees of flexion, this trochleoplasty was performed alongside a tibial tubercle osteotomy (TTO), medial patellofemoral ligament (MPFL) reconstruction, and a patellar cartilage transplant.

Procedure Overview:

• Planning & Initial Cuts: The surgeon maps out the patient's original groove and plans a 10 mm correction to correct a highly abnormal tibial tubercle-trochlear groove (TT-TG) distance of 24 mm. Using an osteotome and a specialized saw, the surgeon starts the bone cuts beneath the cartilage layer from the lateral side to the midline, removing a large bone spur at the top of the ridge to gain access.
• Creating the New Groove: Soft tissues are retracted using pins on both sides. The surgeon uses an Arthrex trochleoplasty burr set to a 5 mm depth to avoid penetrating the underlying bone. They work medially and laterally beneath the cartilage flap to mold the bone. Extra care is taken because the young patient's bone is highly sclerotic (dense), requiring cautious hand work to avoid cracking the flap.
• Deepening the Defect: The surgeon switches to a smaller 3 mm depth burr to make the bone flap more pliable. By angling the burr freehand, they sculpt a brand-new groove that is roughly 1 cm deep.
• Building the Wall & Fixation: To further build up the lateral ridge, optimize the groove rotation, and correct the TT-TG alignment, bone graft is packed underneath the lateral side of the flap. Fixation of the newly compressed cartilage floor is achieved using multiple 3.5 mm PushLock anchors threaded with heavy Vicryl sutures. The anchors are systematically placed along the center, medial, and lateral aspects of the new groove to ensure tight compression.
• Recovery Notes: The surgeon applies Tisseel fibrin sealant to cover any tiny gaps and minimize post-operative bleeding. Patients are advised that they will feel a rubbing or crackling sensation (crepitus) from the Vicryl sutures for the first six weeks until they dissolve. While isolated trochleoplasty patients can often bear weight immediately, the addition of the TTO dictates a modified protocol, though early knee bending is encouraged to help compress the cartilage flap into its new deep groove.