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MFC Arthro MACI
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 an arthroscopic MACI procedure targeting a defect on the medial femoral condyle (MFC).
The truncated video highlights several technical adjustments required for this specific anatomic location:
The specialized surgical steps for this massive graft include:
- Defect Verification & Access: With the knee held at 90 degrees of flexion, a small circular cartilage cutter is introduced through a working cannula toward the medial femoral condyle. Dr. Garcia utilizes a slight "wiggle" technique with the cutter to sharply define the margins. This ensures the borders are completely enclosed with clear, stable walls and no blowout on any side.
- Edge Refinement: A small hand curette is carefully swept along the perimeter to clean and finalize the perpendicular borders of the healthy cartilage rim.
- Hemostasis in the Dry Joint: The tourniquet is dropped, and all fluid is evacuated from the joint to establish a completely dry environment. To treat focal bleeding along the exposed bone bed, large, easily retrievable patties soaked in gel thrombin are packed into the defect through the cannula.
- Trajectory Check & Delivery: The rubber dam is removed from the cannula, and the V-Shuttle delivery device is dry-run into the knee to verify a perfectly perpendicular entry angle. Fibrin sealant (Tisseel) is applied to the raw bony floor.
- Graft Implantation: The custom-cut matrix graft is delivered cell-side down. Dr. Garcia notes a brief technical challenge where the graft slipped slightly lower than intended because the underlying sealant had not fully cured. He uses gentle, small touches with a specialized swab to pull the graft back into its optimal, high position.
- Curing & Stability Testing: After allowing the initial layer to set for 3 minutes, a second coating of fibrin sealant is applied across the entire construct. Following a full 6-minute total cure time, the knee is cycled through full flexion and extension. The matrix remains securely adapted to the medial femoral condyle with zero edge lift, completing the procedure.
