Dr. Garcia’s technique for patella cartilage transplants with a TTO.

In this surgical demonstration video, Dr. Grant H. Garcia breaks down his advanced technique for a Patella Cartilage Transplant performed with a Concomitant Tibial Tubercle Osteotomy (TTO).

The surgery addresses a patient with a severe, localized lateral-sided cartilage defect of the kneecap (patella) alongside localized bone marrow swelling (subchondral edema). Additionally, the patient has a structural tracking abnormality known as a highly elevated TT-TG (Tibial Tubercle-Trochlear Groove) distance of 23mm, which means the kneecap is physically pulling out of alignment toward the outer side. To prevent a new cartilage transplant from wearing out, a TTO must be performed at the same time to realign the underlying bone mechanics.

Surgical Process Breakdown

• Exposing and Reaming the Patellar Defect: The surgeon completely flips (everts) the patella outward to gain a perfectly direct view of the cartilage damage on its underside. Dr. Garcia places a specialized central guide pin directly into the center of the lateral defect. He then utilizes a precision reamer to cleanly core down into the damaged bone and cartilage area to a standard depth of roughly 6 to 7 millimeters.
• Harvesting and Custom Sizing the Cartilage Graft: Turning to the donor bone (allograft), the surgical team matches the anatomical origin and alignment of the patient's native kneecap facet. Dr. Garcia uses a coring saw to extract a healthy bone and cartilage plug. He applies constant fluid irrigation during the drilling to prevent any thermal (heat) damage to the delicate, living cartilage cells (chondrocytes) and the surrounding trabecular bone structure.
• Back-Table Tailoring: The harvested core plug is brought over to a sterile back-table workstation. The surgical team cuts and fine-tunes the underside of the bone block, using a specialized ruler to measure all four quadrants meticulously. This ensuring that the depth of the plug matches the patient's prepared recipient socket down to the millimeter.
• Implanting and Microfracture Conditioning: Before seating the new graft, Dr. Garcia punches small microfracture holes directly into the base of the patient's open socket. This stimulates local bone marrow and bleeding, which drastically improves how well the graft incorporates into the native bone. The edges of the graft are smoothed down, and the plug is gently pressed into position, achieving pristine, flush congruity with the surrounding cartilage.
• TTO Alignment, Lateral Release, and Tracking Assessment: With the delicate cartilage graft safely in place, the surgeon shifts his focus to correcting the severe mechanical pull. He performs a large lateral release (cutting the tight outer structures of the knee) to relieve lateral tension. He then cuts, repositions, and rigidly fastens the tibial tubercle osteotomy bone block lower on the shin to correct the high 23mm tracking distance. To conclude, he ranges the knee all the way to 90 degrees of flexion with his finger placed over the joint, confirming there is absolutely no clicking, catching, locking, or edge-loading on the newly transplanted cartilage graft.