Dr. Garcia’s pediatric technique for MPFL reconstruction to save the patient’s growth plates.

In this video, Dr. Grant H. Garcia demonstrates a complex, specialized procedure designed for a pediatric patient experiencing recurring knee dislocations. The operation combines a physeal-sparing MPFL (Medial Patellofemoral Ligament) reconstruction with the repair of a large OCD (Osteochondritis Dissecans) lesion. Because the patient is a growing child, the primary objective is to protect and entirely avoid damaging the open growth plates (physes).

The surgical description involves:

• OCD Fragment Harvesting & Bed Preparation: The surgeon addresses a large cartilage-and-bone fragment (over two centimeters in size) that had broken off during a previous dislocation and become trapped on the outside of the joint. Dr. Garcia retrieves this fragment, clears away the surrounding scar tissue, and shapes it. He then drills tiny holes into the empty bone bed to stimulate blood flow and marrow growth before pressing the fragment back into its original home.
• Bio-Compression Screw Fixation: To anchor the loose cartilage fragment firmly without using metal that could interfere with growth, the surgeon uses three tiny bio-compression screws. These screws are countersunk two millimeters below the cartilage surface to ensure they remain perfectly flush and don't scratch the resting groove of the knee.
• Physeal-Sparing Femoral Tunnel Alignment: Turning to the MPFL reconstruction, the surgeon navigates a medial approach under careful X-ray (fluoroscopic) guidance to find Schöttle’s point (the natural ligament attachment site). To completely avoid the nearby femoral growth plate, the guide pin is carefully aimed roughly 15 degrees downward (distal) and 15 degrees forward (anterior) before drilling a shallow, 20mm socket.
• Graft Inserter Implementation: Dr. Garcia uses a semitendinosus tendon allograft. He employs a "dunking technique" with a fork-tipped SwivelLock anchor to secure the graft into the femoral tunnel without disturbing the growth plate. A stay-stitch holds the tendon down to prevent it from twisting during placement.
• Patellar Fixation & Tensioning: To attach the other end of the graft to the kneecap without disrupting the newly repaired cartilage patch, the surgeon places two small suture tacks into the patella. With the knee bent between 45 and 50 degrees to correctly seat the kneecap, the graft limbs are secured using a whip-stitch tension slide technique and locked down with alternating half-hitch knots.
• Final Inspection: The knee is guided through its full range of motion to ensure the graft maintains proper tension and tracking (isometry) from 0 to 90 degrees, and a final arthroscopic look confirms that both the reconstructed ligament and the repaired cartilage patch are sitting perfectly flush outside the joint capsule.