Matthew J. Matava, MD, Evan Ellis, MD and Brian Gruber, MD J Am Acad Orthop Surg, Vol 17, No 7, July 2009,
Major advances have been made recently in the areas of posterior cruciate ligament (PCL) anatomy and biomechanics, and several basic science studies have attempted to clarify the variables relevant to the optimal methods of PCL reconstruction. The emerging science concerning the PCL relates primarily to the biomechanical benefits of the inlay technique of tibial fixation compared with traditional tunnel fixation, use of one versus two reconstructive graft bundles, location of the femoral tunnels, and the ideal degree of graft tensioning. Despite these advances, the conclusions concerning these relevant issues are often in conflict, even with well-conceived experimental designs. Although basic knowledge regarding evolving reconstructive methods is improving, many questions remain unanswered. As a result, it is difficult to advocate one particular reconstructive technique. The optimal method of PCL reconstruction can be determined only with continued advances in basic science studies and the implementation of carefully conceived clinical trials isolating one reconstructive variable.