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Dr. Garcia’s updated BEAR ACL repair technique with tightrope fixation
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 demonstrates a hybrid orthopedic procedure featuring Dr. Garcia’s updated BEAR (Bridge-Enhanced ACL Restoration) ACL repair technique combined with tightrope fixation.
The procedure follows these key steps:
- Preparation and Assessment: The surgeon begins with a notchplasty to address the grade two ACL tear. Working in a figure-four position, they debris the stump and use a Freer elevator to separate the ACL from the PCL safely before microfracturing the notch to foster healing.
- Suture Management: Using 35 mm fiber rings, the surgeon places stitches through both the medial and lateral sides to secure the anteromedial bundle. This order is intentionally chosen to verify that the tissue quality is high enough for a successful repair.
- Fixation and Tensioning: A spade tip drill and bow guide are used to create the tunnel. The fiber rings are engaged into the tightrope system, pulling the button to the lateral cortex (verified by X-ray). The ACL is fully tensioned back to the wall, pulling out all slack prior to handling the internal brace.
- Implant Delivery: After making an arthrotomy and drying the joint, the surgeon loads the BEAR implant onto the internal brace. Crucially, the fiber tapes are threaded directly through the center of the implant.
- Blood Infiltration and Finalization: The implant is saturated with 20 cc's of the patient's whole blood. Once the implant softens slightly, it is pushed into the knee joint up to the femoral wall. The procedure concludes by tightening the fiber tapes and securing them with a SwiveLock anchor, creating a stable, fully tensioned repair designed to accelerate natural healing.
