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Dr. Garcia’s technique for a High tibial osteotomy with an ACL reconstruction using a 3D printed custom guide.
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 surgical video, Dr. Grant H. Garcia demonstrates a highly complex joint-preservation procedure: a Combined High Tibial Osteotomy (HTO) and Anterior Cruciate Ligament (ACL) Reconstruction.
This dual operation is performed for active patients who suffer from chronic ACL deficiency alongside medial compartment knee osteoarthritis (bow-legged misalignment). The HTO shifts the patient's weight-bearing line from the worn-out medial (inner) side of the knee to the healthy lateral (outer) side, while the ACL reconstruction restores stability.
To solve the historical challenge of these two procedures physically interfering with one another, Dr. Garcia utilizes a custom 3D-printed jig system (NewClip).
Surgical Process Breakdown
- Exposing and Protecting the Bone: Dr. Garcia makes a slightly larger incision on the medial side of the upper tibia to accommodate the custom hardware. He carefully develops a surgical plane and places a specialized retractor posteriorly (behind the bone) to protect the critical neurovascular structures during the upcoming bone cuts.
- Applying the 3D-Printed Custom Jig: The patient-specific 3D-printed cutting guide is securely pinned onto the tibia.
- The surgeon drives two specialized depth-marked pins through the jig.
- He then inserts a critical protection pin. This pin serves as a physical hard-stop to prevent the bone cut from traveling too far, avoiding a lateral hinge fracture—a major complication where the outer wall of the tibia accidentally snaps.
- Pre-Drilling the Screw Holes: Before making any bone cuts, Dr. Garcia uses the jig to pre-drill the exact screw holes that will lock the final stabilization plate in place. Some holes are drilled bi-cortical (passing all the way through both sides of the bone), while others are uni-cortical. Pre-drilling ensures that even after the bone is cut and shifted, the plate will line up flawlessly.
- The Osteotomy (The Bone Cut): Using a bone saw and an osteotome (a surgical chisel), the cut is executed across the tibia. The surgeon slowly opens the wedge-shaped fracture site sequentially—starting with a 6mm gap, widening it to 8mm, and finally placing a 10mm wedge graft into the open space.
