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Dr. Garcia’s technique for distal femoral osteotomy
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 technique for distal femoral osteotomy," demonstrates an opening-wedge distal femoral osteotomy (DFO) performed using a modern plate system. This procedure is indicated for patients with a knock-knee deformity (significant valgus alignment) who experience localized pain in the lateral compartment of the knee joint.
The procedural steps shown in the video include:
- Diagnostic Arthroscopy and Exposure: The procedure begins with a quick joint scope to verify that the cartilage damage is restricted to the outer (lateral) side of the knee. A lateral-based skin incision is then made, the IT band is split, and the vastus lateralis muscle is carefully lifted. Nearby perforating blood vessels are cauterized to prevent bleeding and retraction.
- Guide Pin Placement: Under X-ray (fluoroscopic) guidance, the surgeon aims a blunt pin toward the adductor tubercle on the opposite side of the femur. The alignment plate is held against the bone to verify that the guide pin angle is correct and will not interfere with future screw holes.
- Bone Cutting (Osteotomy): The surgeon performs blunt dissection across to the medial side of the femur to protect soft tissues. Using a highly controlled oscillating saw and relying on the guide pins for trajectory, a careful cut is made through the bone. The surgeon leaves about one centimeter of the medial cortex intact to act as a hinge, preventing a complete fracture.
- Gradual Correction: To correct the leg's alignment, the surgeon inserts expanding metal wedges into the cut bone gap, slowly working from a 6mm wedge up to a 12mm wedge. This slow expansion safely creates a controlled greenstick fracture at the opposite cortex.
- Alignment and Plate Fixation: A long metal alignment rod is checked across the hip, knee, and ankle to confirm that the weight-bearing line has shifted perfectly toward the medial tibial spine. The anatomically shaped plate is pinned down, centered on the femur, and secured.
- Final Screw Insertion: Temporary cortical compression screws are used to draw the plate flush to the bone before being swapped out for final locking screws above and below the osteotomy gap. The surgeon notes that long screws are critical for a strong fixation construct, but cautions that the lowest screws must not plunge deep enough to damage the nearby trochlea (kneecap groove). The remaining bone gap is filled with an osteoinductive wedge graft to promote fast healing.
