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Fertilized ACL Using Quad Autograft
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 surgical video, Dr. Grant H. Garcia demonstrates his technique for a "fertilized" ACL reconstruction using a quadriceps tendon autograft and an internal brace. This biological optimization technique introduces bone marrow aspirate and demineralized bone matrix (DBM) to improve graft-to-bone healing and speed up tunnel incorporation.
The main steps of the procedure are:
- Biologic Preparation: A biological mixture is prepared combining bone marrow aspirate (BMA)—harvested to recruit native stem cells and growth factors—with DBM putty.
- Femoral Tunnel Fertilization & Graft Passage: After drilling the bone tunnels, a femoral passing button is advanced. Before pulling the tendon graft into place, the femoral tunnel is packed and filled with the BMA-DBM putty mixture. The quadriceps tendon autograft is then drawn up directly into this biologic slurry, ensuring the healing graft is coated at the bone interface.
- Tibial Tunnel Packing & Fixation: Attention is turned to the tibial side, where a full bone tunnel has been drilled. The high-strength internal brace is threaded through an Attachable Button System (ABS) button. Before sinking the button completely flush against the bone cortex, the tibial tunnel is fully packed with the remaining putty mixture until it begins to extrude slightly from the tibial aperture.
- Final Tensioning: With the entire length of the bone tunnels densely packed with the biological mix, the tibial ABS button is securely cinched down and back-tensioned.
The final arthroscopic inspection confirms excellent structural tightness of the new ACL construct with no extrusion of the biological graft materials.
