Dr. Garcia’s technique for Patella Tendon (BTB) ACL surgery, a great option for high level athletes.

This video features Dr. Grant H. Garcia demonstrating the surgical technique for an Anterior Cruciate Ligament (ACL) Reconstruction using a Bone-Patellar Tendon-Bone (BTB) Autograft. This specific procedure is widely recognized as the gold standard for high-level, pivoting athletes due to its unmatched structural stiffness and rapid bone-to-bone healing.

Surgical Process Breakdown

• Harvesting the BTB Graft: The surgeon begins by making an incision over the front of the knee to expose the extensor mechanism. He isolates the central third of the patellar tendon. Using an oscillating saw, he carefully harvests a small, rectangular bone plug from the bottom of the patella (kneecap) and a matching bone plug from the tibial tubercle (shinbone), leaving them securely connected by the natural tendon strip.
• Back-Table Graft Preparation: The harvested graft is moved to a sterile back-table workstation. The bone plugs are sculpted and trimmed into smooth cylinders to ensure they will glide smoothly into the surgical tunnels. Small holes are drilled through each bone block, and high-strength tracking sutures are threaded through them to allow the surgical team to pull and pull the graft into the knee.
• Arthroscopic Joint Preparation: An arthroscope is inserted into the knee joint to evaluate the space. The remnants of the torn, non-functional ACL are debrided and cleared away. Dr. Garcia maps out the precise, native anatomical footprint of the original ACL on both the femur (thighbone) and the tibia (shinbone).
• Precision Tunnel Drilling: Utilizing specialized anatomical alignment guides, the surgeon drills a tibial tunnel from the front of the shinbone into the joint. He then drills a corresponding femoral socket into the back wall of the thighbone, perfectly matching the original trajectory of the native ligament.
• Graft Passage and Rigid Fixation: The tracking sutures are used to pull the prepared BTB graft up through the shinbone and deep into the thighbone socket. Once the graft is perfectly centered and the bone plugs are seated flush within their respective tunnels, the surgeon applies maximum physical tension to the graft. He drives interference screws right alongside the bone blocks, wedging the donor bone tightly against the patient's bone for immediate, rigid mechanical stability.
• Donor Site Management: To address the common post-operative side effect of anterior knee pain (pain at the front of the kneecap), Dr. Garcia fills and packs the empty bone defects left from the harvest site with bone graft putty or leftover cancellous bone fragments. This encourages the harvested gaps to fill in rapidly during the recovery process.