Pcl Technique Guide

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Technique
Guide

VersiTomic®
PCL Technique

Michael A. Rauh, MD
The opinions expressed are those of Dr. Rauh
and are not necessarily those of Stryker

VersiTomic PCL Technique

Michael Rauh, M.D. is an Orthopaedic Sports Medicine specialist at the University at Buffalo. His surgical cases
focus on the latest techniques in arthroscopic surgery of the knee, shoulder, and elbow, as well as, general orthopaedic
reconstructive surgery, and trauma surgery. During his Sports Medicine Fellowship at the renowned Cleveland
Clinic, Dr. Rauh worked with the Cleveland Browns, Indians, and Cavaliers. While in Buffalo, Dr. Rauh serves
as the medical director and team physician for the Buffalo Bandits of the National Lacrosse League. Dr. Rauh is
the Clinical Assistant Professor of Orthopaedic Surgery for the School of Medicine and Biomedical Sciences,
University at Buffalo, where he teaches orthopaedic sports medicine fellows, residents, medical students, and
conducts research.
Michael Rauh, M.D
Orthopaedic Sports Medicine specialist at the University at Buffalo and
Clinical Assistant Professor of Orthopaedic Surgery, School of Medicine and Biomedical Sciences, University at Buffalo

I ntroduction

Surgeons should consider anatomy, scientific evidence and their own experience when deciding
to perform this surgery as well as considering single versus double bundle PCL reconstructions.

Arthroscopic Evaluation and Debridement
1. Care is taken to identify the anatomic insertion points of the PCL on both the femur and
tibial surfaces.
2. The PCL remnant on the medial wall of the intercondylar notch is debrided arthroscopically.
Note the respective PCL footprints, especially if choosing to perform double bundle
reconstructions.
3. Creation of a posteromedial portal is usually helpful. This can be accomplished with spinal
needle localization and visualization with a 70° arthroscope through the notch superior to
the ACL. A posteromedial cannula is often useful to aid in later insertion and removal of
instruments and arthroscope.
Locate tibial PCL footprint and begin to remove the remaining PCL fibers using a combination
of shaver, Stryker PCL Curette, and Stryker PCL Liberator/Rasp.
Stryker PCL Liberator/Rasp has 3 functions:
• Liberator with a tapered tip for elevating soft tissue
• Rasp to assist in removal of tissue/bone
• The pin hole located just above the rasp can serve as a pin protector while reaming the tibial tunnel

Tibial
S Guide Assembly

Unscrew the knob until it is in its final unlock position, press in the button and slide tibial
arm into place. Adjust angle and tighten down the knob to the lock position. Squeeze sides
of Backstopper and slide over distal aspect of tibial spine into slots.

Pre-chuck the 2.4mm guide pin up to the back of the
Backstopper to provide a positive stop when drilling.
This is done to assist in preventing over drilling of the
tibial pin.

Ensure the pin meets the PCL capture cup.

Figure 1b.
Figure 1c.

Tibial Tunnel Guide Placement
1. A 30° arthroscope is placed into the PM portal.
2. Insert the Stryker PCL Tibial Arm into the joint through the AM portal.
Tips:
• Central or AM portal helps to avoid condyles
• Remove bullet entirely when inserting the guide
• Hold upside-down as bringing it into incision, then flip around once inside joint
The guide is designed to accommodate two PCL tibial tunnel insertion sites
(based on surgeon preference and specific to each patient’s individual anatomy).
• Posterior View A: within the native PCL footprint
• Posterior View B: approximately 14 mm down the back of the tibia (when
bottomed out against tibial plateau)
Figure 2.

Posterior View A

Posterior View B

Tibial Tunnel
Use the pre-chucked 2.4 drill tip guide pin to drill tibial tunnel. Be sure to flip down the Backstopper and drill until the Jacob’s Chuck hits the Backstopper,
which oocurs when the 2.4 guide pin tip should be inside the PCL capture cup. Fluro may be used to monitor/evaluate pin. Drilling should occur
with visualization through the PM portal.
Pin Protector
The PCL Tibial Arm is designed to be a pin protector. Tips to prevent advancement of the
guide pin through the PCL capture cup window:
• Remove the Bullet and Backstopper
• Drop your hand to capture the guide pin in the ‘cup’ of the guide, away from the ‘window’
• Alternatively, you can use the hole in the Liberator/Rasp as a pin protector.
The position of the guide pin is verified using fluoroscopy. Drill tibial
tunnel using appropriate sized Stryker VersiTomic Cannulated Drill.
Completion of the tibial tunnel drilling may be done by hand reaming.

Figure 3.

Femoral Tunnel – Outside-In
For the outside-in technique, the PCL Femoral Arm is attached to the tibial spine
and inserted into the joint. Laser lines on the femoral arm help to measure
distance from the articular cartilage. Care is taken to ensure anatomic tunnel
placement whether performing single or double bundle reconstructions.
Make a small incision and advance the guide bolt through medial soft tissues and
secure to bone.
Drill the pin from outside – in and advance the reamer over the guide pin.

Figure 4.

Graft Passage and Fixation
Use a grasper, 18 gauge wire, or surgical wire to pass a suture loop through the tibial tunnel. Use the suture manipulator or probe to pull the suture through joint space and out the anterolateral portal. Use the eyelet of the femoral pin to
pass suture through femoral tunnel. Use passing suture to pass the graft through the tibial tunnel and femoral tunnels.
Graft fixation techniques and implants are surgeon and patient specific based upon implant IFU, patient anatomy, and
surgeon preference.

Notes:

PART NUMBER

DESCRIPTION

234-020-181

Tibial Drill Guide Spine

234-020-182

Tibial Drill Guide Bolt

234-020-126

PCL Tibial Arm

234-020-127

PCL Femoral Arm

234-020-128

PCL Backstopper

234-020-131

PCL Liberator/Rasp

234-020-132

PCL Curette

234-040-050

5.0mm VersiTomic Cannulated Drill

234-040-055

5.5mm VersiTomic Cannulated Drill

234-040-060

6.0mm VersiTomic Cannulated Drill

234-040-065

6.5mm VersiTomic Cannulated Drill

234-040-070

7.0mm VersiTomic Cannulated Drill

234-040-075

7.5mm VersiTomic Cannulated Drill

234-040-080

8.0mm VersiTomic Cannulated Drill

234-040-085

8.5mm VersiTomic Cannulated Drill

234-040-090

9.0mm VersiTomic Cannulated Drill

234-040-095

9.5mm VersiTomic Cannulated Drill

234-040-100

10.0mm VersiTomic Cannulated Drill

234-040-105

10.5mm VersiTomic Cannulated Drill

234-040-110

11.0mm VersiTomic Cannulated Drill

234-040-115

11.5mm VersiTomic Cannulated Drill

234-020-148

5mm Femoral Reamer 3-Fluted

234-020-028

5.5mm Femoral Reamer 3-Fluted

234-020-062

6mm Femoral Reamer 3-Fluted

234-020-029

6.5mm Femoral Reamer 3-Fluted

234-020-061

7mm Femoral Reamer 3-Fluted

234-020-030

7.5mm Femoral Reamer 3-Fluted

234-020-008

8mm Femoral Reamer 3-Fluted

234-020-031

8.5mm Femoral Reamer 3-Fluted

234-020-009

9mm Femoral Reamer 3-Fluted

234-020-032

9.5mm Femoral Reamer 3-Fluted

234-020-010

10mm Femoral Reamer 3-Fluted

234-020-033

10.5mm Femoral Reamer 3-Fluted

234-020-011

11mm Femoral Reamer 3-Fluted

234-020-034
234-020-078

11.5mm Femoral Reamer 3-Fluted
12mm Femoral Reamer 3-Fluted

A surgeon must always rely on his or her own professional clinical judgment when deciding whether to use a particular
product when treating a particular patient. Stryker does not dispense medical advice and recommends that surgeons
be trained in the use of any particular product before using it in surgery.
The information presented is intended to demonstrate the breadth of Stryker product offerings. A surgeon must
always refer to the package insert, product label and/or instructions for use before using any Stryker product. Products
may not be available in all markets because product availability is subject to the regulatory and/or medical practices
in individual markets. Please contact your Stryker representative if you have questions about the availability of
Stryker products in your area.
Stryker Corporation or its divisions or other corporate affiliated entities own, use or have applied for the following
trademarks or service marks: Stryker, VersiTomic. All other trademarks are trademarks of their respective
owners or holders.
Literature Number: LJPVTPCL-BR Rev. 1
MS/GS 01/12
Copyright © 2012 Stryker
Printed in USA

325 Corporate Drive
Mahwah, NJ 07430
t: 201 831 5000
www.stryker.com

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Pcl Technique Guide