Grant Garcia’s Post

Name: Grant Garcia on LinkedIn: #arthrex #patella #patelladislocation #instability #backinthegame…
Uploaded: 2024-05-28T13:00:08.562Z
Channel: Grant Garcia

Grant Garcia

Sports, Elbow, Cartilage and Shoulder Surgeon at Orthopedic Specialists of Seattle, CoFounder SportsDocTalk Podcast, New Technology Consultant, Healthcare Startup Advisor, Innovator

5mo

Patella dislocations can come with many different nuances. Understanding risk factors for recurrence, cartilage damage and dysplasia are important. What can make things more challenging is open growth plates in addition to a large OCD. Check out this recent case of a 14 year old with open growth plates and a large OCD. Unfortunately there was not fragment remaining to fix back to I decide to add an off the shelf osteochondral product Prochondrix. In addition I preformed a growth plate sparing MPFL reconstruction. This MPFL technique has been a workhorse for me in patients with open physes. For more information visit my website below. Pediatric MPFL Reconstruction: https://lnkd.in/gDykzxu7 #arthrex, #patella, #patelladislocation, #instability, Proliance Surgeons, Orthopedic Specialists of Seattle, PELTO Health Partners, Sports Doc Talk Podcast, William Sanchez, Wayne Weil, Anthony Yi, #backinthegame, #sportsinjury #sports #cuttingedgetechnology, #innovation #innovationinhealthcare

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This is a more unique case, the patient with open growth plates with recurrent Patella instability as well as a moderate to large sized defect on the medial portion of Patella after a single dislocation. You can see we have to remove the piece of the posterior aspect of the knees, you know, accessory portal. And then here we're going to place two. These are new 2.6 knee fiber attacks. They're double loaded. And again, we're going to start off with the 2.8 drill followed by a three OH drill to help us get into this difficult bone. You can see we're having counter traction on the knee because the Patella can be slightly harder in terms of bone placement. And again, we're going to place two of these. You can see the knotless function and we're going to engage this at the end. We're going to find the growth plate and shuttles point on the lateral view. And then we're going to do an AP. And you can see here that we're we've identified we're below the growth plate and then we're going to ream. A socket around 20 to 25mm. This is a fork tip silver lock. This is a semi tee allograft. We place this over the fork tip portion. There is a suture in the middle to hold this in, and then we're going to spread it out wide. You can see here we're at the insertion point. Again, this is the opposite of what we do our standard MP file reconstructions. If you see my previous videos, we're going to dunk this in. And then we're going to fixate the graft here. This is a 7mm. Swivel lock. And we are pushing this in, but we're holding it back on either side to make sure that we do not spin the graft. Then we're going to take the stay suture, tie in the graft and then take any of the other remaining sutures that were originally used to dunk it in and tie in the graph as well as a backup check ring. Once these are tied, and we've already checked isometry before doing this. We're going to cut the sutures. And then we're going to pass. So we're going to pass individually, but first we're going to identify the defect. You can see defect is over a centimeter. It's all the way down to bone, but it is well encapsulated. Again, this is a single stage procedure and this patient, this patient is young. We want to do a single stage. We want to have some sort of allograft option without having to do fresh allograft. As we had to take care of this in a more prompt than not basis. So we're using this small remind device to get down to the subchondral bone and then we're going to clear out the surrounding tissue similar to what we do other cartilage procedures. Once we have good rim, then we're going to. Microfracture here. This is using a .42 K wire. This is going to help bring stem cells from these below the subchondral bone. We're going to place the seal on the defect and then we're going to open this pre shaped procond Drax. Graft and this is both bone and cartilage forming. We're going to hold this for roughly 3 minutes and then place another round of to seal to seal this in. Once this is fully sealed, then we're going to range. Then you can see here we've got excellent fixation. We're going to arrange the knee significantly and check it again. You can see that there is no pull off of the graph. It is quite stable during this round. We've had excellent results with this type of procedure. Now we're going to place any roughly about 45. Degrees and then we're going to check that it holds when we go into full extension. It's not over tightened. You can see you're putting decent amount of force. And then we're going to fix this using the knotless function again. This is a single knotless with also a repair stitch on it as well. And then we're going to check to make sure this is isometric again. So we're bringing into full extension. You can see that we have less than two quadrants. We've not over constrained the knee and this can go all the way to full flexion if needed. Now we're going to repeat this for the 2nd limb if you have. Little bit of concern, you can always make this second limp a little bit tighter, but in this case we were happy with the placement. Again, we're going to cinch this down. Now you've cinched down to tails of the graft and we're going to check it one more time to make sure that we have not over constrained the knee. Following this, we're going to tie the graft and then we're going to remove the remaining hamstring graft from above and then we'll actually use the repair stitch to repair the vastus, medialis, et cetera. So these anchors are quite versatile in this situation. Thank you.

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Grant Garcia

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Osteochondritis dissecans diagnosis and treatment can be confusing and there are several variables involved. Check out my second segment below overviewing diagnosis and basic treatment. To learn more about this condition check out my website section below. Stay tuned for weekly updates! Orthopedic Specialists of Seattle we offer all levels of care for these advanced cartilage injuries. Website: https://lnkd.in/gdDrQDzS #cartilagetransplant, #osteochondritisdessicans, Arthrex, #cartilagerestoration #osteotomy #DFO #HTO #TTO #savethemeniscus, #savetheknee #preservation #instability, Proliance Surgeons, Orthopedic Specialists of Seattle, PELTO Health Partners, Sports Doc Talk Podcast, William Sanchez, Wayne Weil, Anthony Yi, Andre Shaffer, Auston Robinson, MBA, Drew Osika, Robert Benedict, MBA, CTBS, Rachel Frank MD, #backinthegame, #sportsinjury #sports #cuttingedgetechnology, #innovation #innovationinhealthcare
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Grant Garcia

Sports, Elbow, Cartilage and Shoulder Surgeon at Orthopedic Specialists of Seattle, CoFounder SportsDocTalk Podcast, New Technology Consultant, Healthcare Startup Advisor, Innovator
4mo Edited
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Osteochondritis dissecans can be a challenging diagnosis. In some cases, non-operative treatment is needed, in others arthroscopic fixation and sometimes more complex surgeries are needed such as a cartilage transplant. Depending on age the treatment options also change. Check out my brand-new blog post which is part 1 of 4 segments on OCDs which will include diagnosis, management, basic and advanced treatment. To learn more about this condition check out my website section below. Stay tuned for weekly updates! Orthopedic Specialists of Seattle we offer all levels of care for these advanced cartilage injuries. Website: https://lnkd.in/gdDrQDzS #cartilagetransplant, #osteochondritisdessicans, Arthrex, #cartilagerestoration #osteotomy #DFO #HTO #TTO #savethemeniscus, #savetheknee #preservation #instability, Proliance Surgeons, Orthopedic Specialists of Seattle, PELTO Health Partners, Sports Doc Talk Podcast, William Sanchez, Wayne Weil, Anthony Yi, Andre Shaffer, Auston Robinson, MBA, Drew Osika, Robert Benedict, MBA, CTBS, Rachel Frank MD, #backinthegame, #sportsinjury #sports #cuttingedgetechnology, #innovation #innovationinhealthcare

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Grant Garcia

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Cartilage injuries can be daunting for patients. In many cases it can be months to years before they get the diagnosis. Even more frustrating given its a niche speciality, many times they are told there is nothing that can be done. As I have posted before this is an exploding area of research and technology advancement. Its important for our patients to understand the nuances of these injuries, from presentation, diagnosis and treatment. I present to you a recent simplified overview of cartilage injuries. At Orthopedic Specialists of Seattle we offer one of the most cutting edge and exhaustive list of options in Washington State. For more information check out my website below. Cartilage Restoration: https://lnkd.in/gdFtzvsa #cartilagetransplant, Arthrex, #cartilagerestoration #osteotomy #DFO #HTO #TTO #savethemeniscus, #savetheknee #preservation #instability, Proliance Surgeons, Orthopedic Specialists of Seattle, PELTO Health Partners, Sports Doc Talk Podcast, William Sanchez, Wayne Weil, Anthony Yi, Andre Shaffer, Auston Robinson, MBA, Drew Osika, Robert Benedict, MBA, CTBS, Rachel Frank MD, #backinthegame, #sportsinjury #sports #cuttingedgetechnology, #innovation #innovationinhealthcare
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Grant Garcia

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As a cartilage surgeon not everything is cut and dry. Many times, I must use my experience, past surgical outcomes, and the latest research to offer the best treatment plan. Vericel® Corporation MACI cartilage treatment is my workhouse given its high healing rate, ability to cover multiple lesions and that it doesn’t burn any bridges for other cartilage procedures. In many cases if you fix alignment, you can push the envelope on the cartilage portion. Check out below this perfect example of this young female with a tough 3 defect knee injury. We did a tibial tubercle osteotomy with MACI of her patella, trochlea and condyle and she did amazing (she is over 2 years out!). As challenging as this outcome is, check out our link below to see other testimonials like this one. Its patients like this that motivate me to continue to push the technology available. Orthopedic Specialists of Seattle we offer the most cutting edge cartilage restoration procedures in Washington. MACI: https://lnkd.in/gDqXzV5K #MACI, Vericel® Corporation, #MACI #cartilagerestoration #osteotomy #DFO #HTO #TTO #savethemeniscus, #savetheknee #preservation #instability, Proliance Surgeons, Orthopedic Specialists of Seattle, PELTO Health Partners, Sports Doc Talk Podcast, William Sanchez, Wayne Weil, Anthony Yi, Andre Shaffer, #backinthegame, #sportsinjury #sports #cuttingedgetechnology, #innovation #innovationinhealthcare Video Testimonial

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