Pcl Technique Guide

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Technique

Guide

Michael A. Rauh, MD

e opinions expressed are those of Dr. Rauh

and are not necessarily those of Stryker

PCL Technique

VersiTomic®

VersiTomic PCL Technique

Michael Rauh, M.D. is an Orthopaedic Sports Medicine specialist at the University at Bualo. 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 Bualo, Dr. Rauh serves

as the medical director and team physician for the Bualo 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.

Introduction

Michael Rauh, M.D

Orthopaedic Sports Medicine specialist at the University at Bualo and

Clinical Assistant Professor of Orthopaedic Surgery, School of Medicine and Biomedical Sciences, University at Bualo

Surgeons should consider anatomy, scientic 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. e 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. is can be accomplished with spinal

needle localization and visualization with a 70° arthroscope through the notch superior to

the ACL. A posteromedial cannula is oen useful to aid in later insertion and removal of

instruments and arthroscope.

Locate tibial PCL footprint and begin to remove the remaining PCL bers 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

•epinholelocatedjustabovetheraspcanserveasapinprotectorwhilereamingthetibialtunnel

Unscrew the knob until it is in its nal 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.

is is done to assist in preventing over drilling of the

tibial pin.

Ensure the pin meets the PCL capture cup.

S

Tibial Guide Assembly

a

b

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iparoundonceinsidejoint

e guide is designed to accommodate two PCL tibial tunnel insertion sites

(based on surgeon preference and specic 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.

Figure 1b.

Posterior View A Posterior View B

c

Figure 1c.

Tibial Tunnel

Figure 3.

S

Femoral Tunnel – Outside-In

Usethepre-chucked2.4drilltipguidepintodrilltibialtunnel.Besuretoip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

e 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.

epositionoftheguidepinisveriedusinguoroscopy.Drilltibial

tunnelusingappropriatesizedStrykerVersiTomicCannulatedDrill.

Completion of the tibial tunnel drilling may be done by hand reaming.

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 manipula-

tor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:

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 11.5mm Femoral Reamer 3-Fluted

234-020-078 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.

e information presented is intended to demonstrate the breadth of Stryker product oerings. 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 aliated 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

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