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Dr. Garcia’s newest technique to fix ACL tibial spine using the new ACL tightrope system
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.
This video, titled "Dr. Garcia’s newest technique to fix ACL tibial spine using the new ACL tightrope system," demonstrates a surgical repair of an acute ACL tibial spine avulsion fracture. In this condition, the ACL ligament itself is healthy, but the piece of bone it attaches to on the tibia has pulled away, causing severe knee laxity.
The surgical procedure shown involves:
- Site Preparation: The surgeon evaluates the knee arthroscopically, noting the elevation of the fractured bone fragment. The bed of the fracture is cleaned and prepared so that the bone fragment can be sunk 1 to 2 millimeters into its native position, which ensures a tight, over-reduced repair that eliminates residual ligament laxity.
- Drilling and Stitching: A specialized guide and a 3.0 cannulated drill are used to create a tunnel through the fracture fragment and down into the tibia. Using a suture-passing device, the surgeon passes 25mm "FiberRing" suture loops through both the anteromedial and posterolateral bundles of the native ACL to secure a high-strength grip on the tissue.
- Shuttling the TightRope Device: The surgeon routes the loops outside the joint capsule and introduces the specialized ACL TightRope repair system. The FiberRings are sequentially interlocked directly into the loop mechanism of the TightRope device.
- Tensioning and Button Fixation: The assembled construct is pulled back down through the drilled bone tunnel. The suture limbs are marked from the outside to trace the tension. With the knee held in full extension to prevent impingement, the surgeon pulls sequentially on the TightRope limbs to seat and tighten a metal button flat against the outer surface of the tibia bone.
- Final Evaluation: The surgeon visualizes the joint at 90 degrees of flexion and in full extension, verifying that the bone fragment is perfectly flush, the ACL is extremely taut, and there is zero knee impingement. A manual Lachman test is performed on the leg to confirm complete physical stability of the restored ACL.
