Posterior Cruciate Ligament

The posterior cruciate ligament (PCL) is the primary restraint to posterior tibial translation of the knee. PCL tears may occur in isolation but are more often a component of combined injuries, with concomitant injuries classically involving multiple ligaments, chondral defects and meniscal tears. Tools for initial diagnosis and postoperative assessment, including stress radiography, have helped provide quantitative information on which to base surgical indications and outcomes after reconstruction. Treatment of PCL injuries range from nonoperative dynamic bracing for acute, isolated PCL injuries (grades I and II) to surgical reconstruction for acute grade III injuries or those with concurrent ligament injuries or repairable meniscal tears. Reconstructions historically have included both anatomical single bundle PCL reconstruction (PCLR) and anatomical double bundle (aDB) PCLR. Single bundle reconstructions are focused on the larger anterolateral bundle; however, single bundle reconstructions have been reported to have residual posterior and rotational tibial laxity. Consequently the aDB-PCLR has become the preferred reconstruction method for restoring the native anatomy of the bundle footprints and knee kinematics. The goal of this chapter is to provide a detailed review of PCL anatomy and biomechanics, diagnostic tools, surgical indications and operative techniques with a focus on arthroscopic double bundle PCL reconstruction.