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Dr. Garcia demonstrates the new Arthrex BTB Fibersnare
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 modified ACL revision technique using a new BTB (Bone-Patellar Tendon-Bone) FiberSnare system to incorporate an independent internal brace alongside a patellar tendon graft.
The procedure follows these primary steps:
- Graft Passage & Initial Fixation: The TightRope fixation system is deployed to pull the patellar tendon autograft into position, while the internal brace is isolated and pulled out through the medial portal. Because this is a revision surgery, an initial screw is placed to safely replace the old hardware and prevent tunnel blowout. A primary interference screw is then driven into the tunnel over the graft, securing the bony portion of the patellar tendon.
- Independent Internal Brace Loading: Rather than threading the internal brace directly through the graft itself, the separate internal brace is routed to sit cleanly over the top of the patellar tendon. Dr. Garcia passes a FiberSnare directly through the center of the cannulated interference screw, captures the two FiberTapes of the internal brace, and effortlessly pulls them down through the screw.
- Sequential Tensioning & Fixation: This approach allows the surgeon to confirm that the native ACL graft is perfectly taut on its own before engaging the secondary backup. With the leg held at full extension to prevent over-constraining the joint, the internal brace tapes (along with any remaining backup sutures) are fully tensioned and secured to the tibia using a 4.75 mm SwivelLock anchor.
- Final Stability Check: The final evaluation confirms a completely restored Lachman test with the internal brace nicely draped over the protected patellar tendon graft.
