Dr. Garcia’s 2026 lateral meniscus transplant video

In this updated surgical video, Dr. Grant H. Garcia demonstrates a complex combined procedure involving a lateral dovetail meniscus transplant and a concurrent cartilage transplant on a patient with a deficient meniscus and a large lateral femoral condyle defect.

The detailed surgical phases include:

• Meniscal Debridement: The procedure begins by resecting the remnants of the native, damaged meniscus (particularly the anterior horn). Dr. Garcia utilizes various specialized biters, aiming to preserve a stable 10% peripheral rim of native tissue to suture the new graft against.
• Trough Alignment & Creation: A percutaneous incision is made to achieve straight-line access for the bone slot, which requires a split of the patellar tendon. With the leg positioned in a figure-four stance, a notchplasty is performed to provide unimpeded workspace access. A bone trough is initiated as close to the native ACL as possible to avoid tibial plateau damage.
• Dovetail Slot Preparation: Under fluoroscopic guidance, 6 mm and 7 mm reamers begin drilling the slot. A power rasp and synovial biter (synovial ranger) clear away tissue to expose the trough. Sequential square rasps, angled rasps, and dilators shape the bone. Dr. Garcia notes that he occasionally intentionally blows out the back wall of the tibia to ensure the slot sits as far posterior as possible. To address the common posterior impingement "pinch point," a second specialized box guide is used to open up the superior aspect of the trough.
• Graft Inserter & Cartilage Implantation: An RF device and power rasp clean the path. The open cartilage transplant is completed first, resulting in a smooth contour along the femoral condyle. The lateral meniscus bone plug graft is then loaded into position; the passing stitch pulls the dovetail bone block tightly into the prepared tibial slot until it sits flush.
• Fixation & Meniscal Suturing: Between 7 and 8 inside-out sutures are passed around the peripheral rim to secure the graft body. Because an open incision is already present for the cartilage transplant, the anterior horn can be repaired under direct open visualization.
• Posterior Horn Reinforcement: To robustly secure the posterior horn, high-strength FiberStitches are passed. Dr. Garcia maps these out carefully to remain clear of the popliteal artery. These stitches are placed in a vertical or horizontal fashion, acting as their own "rip-stop" due to the excellent quality of the transplant tissue.
• Final Assessment: A microfracture is performed in the femoral notch to recruit healing factors. The final look shows the entire lateral plateau completely covered and fully supported by both structurally intact transplants.