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Dr. Garcia’s technique using MACI for larger patella cartilage defects.
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 video, Dr. Grant H. Garcia details the procedure for a MACI (Matrix-Induced Autologous Chondrocyte Implantation) of the patella. Because this patient also required joint realignment and offloading of pressure on the kneecap, the MACI is done in tandem with a concomitant Tibial Tubercle Osteotomy (TTO).
The surgical technique highlights the following steps:
- Preparing the Defect Site: The surgeon uses a curette to scrape the damaged area down to a healthy, firm calcified cartilage layer. Neuro-soaked patties are packed into the defect to control capillary bleeding and keep the bed clear.
- Graft Handling and Orientation: Using toothless pickups to protect the graft, the cut membrane is briefly kept in a specimen dish with MACI fluid. Maintaining orientation is critical: the cellular rough side must face down toward the raw bone bed, leaving the shiny side facing up toward the joint space.
- Implantation and Fixation: After ensuring the bone bed is completely dry and free of bleeding, a base layer of Tisseel (fibrin glue) is applied. The MACI membrane is carefully pressed into place. Dr. Garcia applies gentle, steady digital (finger) pressure for about three minutes to allow the glue to bond without crushing the cells.
- Reinforcement: Extra fibrin glue is layered around the edges of the patch and left to dry for an additional three minutes. In an area where the patch was slightly loose or decontained, 6-0 fine sutures are placed to securely anchor it to the surrounding native tissue.
