September 2026 |

The PCL Playbook

By: Ian Al’Khafaji, M.D., F.R.A.C.S., FAANA AANA Communications and Technology Committee

 

The posterior cruciate ligament (PCL) remains poorly understood and management varies widely even among high-volume knee surgeons. Isolated PCL injuries are comparatively uncommon,1,2,3 and combined injuries are heterogeneous, making it difficult to accumulate evidence to guide decision-making. Registries, biomechanical platforms and long-term cohorts have begun to close these gaps, but central controversies persist: single- versus double-bundle reconstruction, transtibial versus tibial inlay fixation, autograft versus allograft, the role of slope-correcting osteotomy and whether reconstruction alters the trajectory toward patellofemoral degeneration. 2,3,4,5

 

An advanced workup never evaluates the PCL in isolation since concomitant posterolateral corner injury is common and changes management. The posterior drawer test at 90° remains the most sensitive maneuver, graded by tibial step-off, paired with the quadriceps active test and posterior sag sign. Most isolated reconstructions are reserved for Grade III injuries. The dial test identifies associated posterolateral corner injury, and gait observation for varus thrust or hyperextension should raise suspicion for chronic injury with medial compartment osteoarthritis.6

 

Imaging should extend well beyond a screening MRI. Posterior tibial slope should be measured on a true lateral radiograph given growing evidence that decreased slope independently predicts both primary injury and graft laxity.7,8,9,10,11,12,13 Quantitative stress radiographs can be obtained to assess chronic injury or postoperative laxity14. PCL injuries can often appear to be healed on MRI but can actually be mechanically deficient. The PCL-posterior femoral cortex angle quantifies chronic “buckling” even when the ligament appears grossly intact on MRI.15,16

 

If one theme unifies recent PCL literature, it is that posterior tibial slope is mechanistically central to both injury and treatment failure. Multiple cohorts, including a pediatric-specific analysis, show decreased slope is independently associated with PCL injury,8 and morphological analyses support a distinct osseous risk profile.7 Long-term studies identify slope as predictive of graft survival and laxity,12,13,17 and biomechanical work supports double-bundle reconstruction with decreased slope.18 Opening-wedge high tibial osteotomy for slope correction now has support as a staged or index procedure in the PCL-deficient knee,19 with an expanding role in genu recurvatum.20

 

Anterior knee pain and patellofemoral degeneration are common long-term complaints in the PCL-deficient patient. Chronic posterior subluxation shifts the tibiofemoral contact axis posteriorly, and biomechanical testing shows this laxity increases patellofemoral contact pressure, particularly at higher flexion angles.21 In vivo analysis confirms isolated PCL injury alters tibiofemoral and patellofemoral kinematics, with abnormal contact patterns persisting even after reconstruction.22,23 Whether reconstruction prevents this is debatable: long-term gait analyses show persistent compensatory changes at the hip, knee and ankle in the postoperative knee.24,25 Reconstruction should be counseled as stability-restoring, not necessarily protective against patellofemoral risk based on current literature.

 

Nonoperative management remains first-line for isolated, low-grade injury and is reasonable in select Grade III injuries in low-demand patients.26 The initial phase involves brief protected weightbearing in a PCL-specific brace applying an anteriorly directed tibial force, followed by progressive, quadriceps-dominant, closed-chain strengthening, since the quadriceps is a dynamic secondary restraint. Open-chain hamstring strengthening should be avoided early, since it directly loads the deficient PCL. The best long-term nonoperative data come from a minimum ten-year follow-up of acute, isolated injury, in which most patients maintained good function and returned to sport, though patellofemoral and medial compartment degeneration was common;26 this should not be over-generalized to combined patterns.

 

Surgical reconstruction is indicated for symptomatic, high-grade instability and essentially all PCL injuries with multiligament or repairable meniscal involvement; the controversy is rarely whether to operate but how. There is no strong evidence favoring autograft over allograft.31,32,33 The PCL is longer than the ACL, so short grafts such as bone-patellar tendon-bone may not be viable, and sources become limited in multiligament cases. Double-bundle reconstruction offers modest stability advantages, consistent with work showing the two bundles are co-dominant,34 though patient-reported outcomes are comparable.28,34,35,36,37,38 Bony tibial avulsion, especially the pediatric “peel-off” pattern, can be treated via primary fixation rather than reconstruction.29 Combined PCL and posterolateral corner or multiligament injury should essentially always be treated operatively, since unaddressed concomitant deficiency is a well-established cause of graft failure.30,6 Decreased slope with recurrent instability or chronic recurvatum should prompt osteotomy rather than reconstruction alone.19,20

 

Tunnel strategy is another perennial debate. Transtibial technique creates an acute posterior tunnel exit angle, the “killer turn,” associated with graft attenuation, while tibial inlay avoids this by fixing the graft directly posteriorly, with superior pretension and reduced laxity.39,40 Inlay complicates positioning for posterior access, so transtibial drilling remains more popular, modified by increasing tunnel guide angle and smoothing the tibial aperture to mitigate the “killer turn.” 41,42,43,44 Femoral tunnel placement is the primary determinant of graft isometry;45 inside-out and outside-in drilling can both achieve anatomic position, though outside-in may create a less favorable bending angle.46,47 Femoral and tibial tunnel convergence is a real risk in multiligament cases and should be accounted for during preoperative planning.48 The anterior lateral bundle should be fixed at 90 degrees of anterior tibial reduction force to minimize residual posterior sag, while a posterior medial bundle should be secured at full extension.5,49,50

 

Unaddressed posterolateral deficiency remains a well-established cause of graft failure, from residual varus/external rotation laxity and increased graft forces.30 Single-bundle reconstruction combined with posterolateral corner reconstruction restores comparably controlled laxity to double-bundle combined reconstruction, so bundle number should not be the deciding variable when a posterolateral procedure is planned.51,52 Earlier, well-planned reconstruction avoids unnecessary accumulation of secondary intraarticular injury.53 Despite this technical sophistication, reported outcomes of PCL reconstruction remain sobering overall: a systematic review and meta-analysis found isolated reconstruction improves function but yields low rates of return to preinjury sport,54 and Norwegian registry data report subjective failure rates approaching 45% to 50% at short-term follow-up in both isolated and combined reconstruction.2 Therefore, setting realistic expectations regarding patients’ return to previous activities remains a crucial aspect of care.

 

References 

  1. Sanders, T.L., Pareek, A., Barrett, I.J., Kremers, H.M., Bryan, A.J., Stuart, M.J., Levy, B.A., Krych, A.J. Incidence and Long-Term Follow-Up of Isolated Posterior Cruciate Ligament Tears. Knee Surgery, Sports Traumatology, Arthroscopy. 2017 Oct;25(10):3017-3023.
  2. Moatshe, G., LaPrade, C.M., Fenstad, A.M., Persson, A., LaPrade, M., Martin, R.K., Engebretsen, L., LaPrade, R.F. Rates of Subjective Failure After Both Isolated and Combined Posterior Cruciate Ligament Reconstruction: A Study From the Norwegian Knee Ligament Registry 2004-2021. American Journal of Sports Medicine. 2024 May;52(6):1491-1497. doi: 10.1177/03635465241238461.
  3. Zsidai, B., Winkler, P.W., Pruneski, J.A., Råkeberg, K., Cristiani, R., Inderhaug, E., Lind, M., Musahl, V., Hamrin Senorski, E., Samuelsson, K., Horvath, A. Delayed Primary Isolated Posterior Cruciate Ligament Reconstruction is Not Associated With Intraarticular Injury Prevalence: A Study From the Scandinavian Knee Ligament Registries. Journal of ISAKOS. 2026 Apr;17:101070. doi: 10.1016/j.jisako.2026.101070.
  4. Deichsel, A., Briese, T., Liu, W., Raschke, M.J., Albert, A., Peez, C., Weiler, A., Kittl, C. Specific Fibre Areas in the Femoral Footprint of the Posterior Cruciate Ligament Act as a Major Contributor in Resisting Posterior Tibial Displacement: A Biomechanical Robotic Investigation. Knee Surgery, Sports Traumatology, Arthroscopy. 2025 Jun;33(6):2010-2018. doi: 10.1002/ksa.12486.
  5. Kennedy, N.I., LaPrade, R.F., Goldsmith, M.T., Faucett, S.C., Rasmussen, M.T., Coatney, G.A., Engebretsen, L., Wijdicks, C.A. Posterior Cruciate Ligament Graft Fixation Angles, Part 1: Biomechanical Evaluation For Anatomic Single-Bundle Reconstruction. American Journal of Sports Medicine. 2014 Oct;42(10):2338-2345.
  6. Hunter, C.D.R., Sternbauer, J., Kammerlander, C., Grillari, J., Neuper, O., Ernat, J.J., Klasan, A. Posterior Cruciate Ligament Involvement Leads to inferior Outcomes In Multiligament Knee Injuries Involving The Medial Collateral Ligament: A Systematic Review and Meta-Analysis. Knee Surgery, Sports Traumatology, Arthroscopy. 2025 Dec 31. doi: 10.1002/ksa.70232.
  7. Huang, W.T., Kang, K., Wang, J., Li, T., Dong, J.T., Gao, S.J. Morphological Risk Factors for Posterior Cruciate Ligament Tear and Tibial Avulsion Injuries of the Tibial Plateau and Femoral Condyle. American Journal of Sports Medicine. 2023 Jan;51(1):129-140. doi: 10.1177/03635465221131295.
  8. Vasudevan, R.S., Rupp, G.E., Zogby, A.M., Wilps, T., Paras, T., Pennock, A.T. Decreased Posterior Tibial Slope and Its Association With Pediatric Posterior Cruciate Ligament Injury. American Journal of Sports Medicine. 2024 May;52(6):1498-1504. doi: 10.1177/03635465241240792.
  9. Nedaie, S., Vivekanantha, P., O'Hara, K., Slawaska-Eng, D., Cohen, D., Abouali, J., Hoshino, Y., Nagai, K., Johnson, J., de Sa, D. Decreased Posterior Tibial Slope is a Risk Factor For Primary Posterior Cruciate Ligament Rupture and Posterior Cruciate Ligament Reconstruction Failure: A Systematic Review. Knee Surgery, Sports Traumatology, Arthroscopy. 2024 Jan;32(1):167-180. doi: 10.1002/ksa.12025.
  10. Li, L., Li, J., Zhou, P., He, Y., Li, Y., Deng, X., Jiang, H., Liu, J., Li, Z. Decreased Medial Posterior Tibial Slope is Associated With an Increased Risk of Posterior Cruciate Ligament Rupture. Knee Surgery, Sports Traumatology, Arthroscopy. 2023 Jul;31(7):2966-2973. doi: 10.1007/s00167-023-07308-z.
  11. Giffin, J.R., Stabile, K.J., Zantop, T., Vogrin, T.M., Woo, S.L., Harner, C.D. Importance of Tibial Slope for Stability of the Posterior Cruciate Ligament Deficient Knee. American Journal of Sports Medicine. 2007 Sep;35(9):1443-1449.
  12. Yoon, K.H., Lee, J.H., Kim, S.G., Park, J.Y., Lee, H.S., Kim, S.J., Kim, Y.S. Effect of Posterior Tibial Slopes on Graft Survival Rates at 10 Years After Primary Single-Bundle Posterior Cruciate Ligament Reconstruction. American Journal of Sports Medicine. 2023 Apr;51(5):1194-1201. doi: 10.1177/03635465231156621.
  13. Gwinner, C., Weiler, A., Roider, M., Schaefer, F.M., Jung, T.M. Tibial Slope Strongly Influences Knee Stability After Posterior Cruciate Ligament Reconstruction: A Prospective 5- to 15-Year Follow-up. American Journal of Sports Medicine. 2017 Feb;45(2):355-361.
  14. Holliday, C.L., Martin, R., Grant, J.A. Comparing the Efficacy of Kneeling Stress Radiographs and Weighted Gravity Stress Radiographs to Assess Posterior Cruciate Ligament Insufficiency. American Journal of Sports Medicine. 2021 Mar;49(4):1017-1022.
  15. Siboni, R., Pioger, C., Mouton, C., Seil, R. The Posterior Cruciate Ligament-Posterior Femoral Cortex Angle: A Reliable and Accurate MRI Method to Quantify the Buckling Phenomenon of the PCL in ACL-Deficient Knees. Knee Surgery, Sports Traumatology, Arthroscopy. 2023 Jan;31(1):332-339. doi: 10.1007/s00167-022-07145-6.
  16. Lertwanich, P., Martins, C.A., Kato, Y., Ingham, S.J., Kramer, S., Linde-Rosen, M., Smolinski, P., Fu, F.H. Contribution of the Meniscofemoral Ligament as a Restraint to the Posterior Tibial Translation in a Porcine Knee. Knee Surgery, Sports Traumatology, Arthroscopy. 2010 Sep;18(9):1277-1281.
  17. Winkler, P.W., Wagala, N.N., Carrozzi, S., Nazzal, E.M., Fox, M.A., Hughes, J.D., Lesniak, B.P., Vyas, D., Rabuck, S.J., Irrgang, J.J., Musahl, V. Low Posterior Tibial Slope is Associated with Increased Risk of PCL Graft Failure. Knee Surgery, Sports Traumatology, Arthroscopy. 2022 Oct;30(10):3277-3286. doi: 10.1007/s00167-021-06760-z.
  18. Bernhardson, A.S., DePhillipo, N.N., Aman, Z.S., Kennedy, M.I., Dornan, G.J., LaPrade, R.F. Decreased Posterior Tibial Slope Does Not Affect Postoperative Posterior Knee Laxity After Double-Bundle Posterior Cruciate Ligament Reconstruction. American Journal of Sports Medicine. 2019 Feb;47(2):318-323.
  19. Dickschas, J., Sendner, T., Schubert, I., Simon, M., Neumaier, M. Anterior Open Wedge High Tibial Osteotomy for Slope Correction as a Successful Method in PCL Insufficiency — Radiological and Clinical Results of a Cohort Study. Knee Surgery, Sports Traumatology, Arthroscopy. 2026 Aug;34(8):2926-2936. doi: 10.1002/ksa.70522.
  20. Cohen, D., Ambrosini, L., Dickschas, J., van Heerwaarden, R., Ollivier, M., Musahl, V. Anterior Opening-Wedge High Tibial Osteotomy for Restoring Posterior Tibial Slope in PCL Insufficiency and Genu Recurvatum: A Narrative Review. Knee Surgery, Sports Traumatology, Arthroscopy. 2026 Jul 22. doi: 10.1002/ksa.70538.
  21. Gill, T.J., DeFrate, L.E., Wang, C., Carey, C.T., Zayontz, S., Zarins, B., Li, G. The Effect of Posterior Cruciate Ligament Reconstruction on Patellofemoral Contact Pressures in the Knee Joint Under Simulated Muscle Loads. American Journal of Sports Medicine. 2004 Jan-Feb;32(1):109-115.
  22. Gill, T.J., Van de Velde, S.K., Wing, D.W., Oh, L.S., Hosseini, A., Li, G. Tibiofemoral and Patellofemoral Kinematics After Reconstruction of an Isolated Posterior Cruciate Ligament Injury: In Vivo Analysis During Lunge. American Journal of Sports Medicine. 2009 Dec;37(12):2377-2385.
  23. Goyal, K., Tashman, S., Wang, J.H., Li, K., Zhang, X., Harner, C. In Vivo Analysis of the Isolated Posterior Cruciate Ligament-Deficient Knee During Functional Activities. American Journal of Sports Medicine. 2012 Apr;40(4):777-785.
  24. Agres, A.N., Brisson, N.M., Duda, G.N., Jung, T.M. Activity-Dependent Compensation at the Hip and Ankle at 8 Years After the Reconstruction of Isolated and Combined Posterior Cruciate Ligament Injuries. American Journal of Sports Medicine. 2024 Jun;52(7):1804-1812. doi: 10.1177/03635465241248819.
  25. Brisson, N.M., Agres, A.N., Jung, T.M., Duda, G.N. Gait Adaptations at 8 Years After Reconstruction of Unilateral Isolated and Combined Posterior Cruciate Ligament Injuries. American Journal of Sports Medicine. 2021 Jul;49(9):2416-2425. doi: 10.1177/03635465211017147.
  26. Shelbourne, K.D., Clark, M., Gray, T. Minimum 10-Year Follow-Up of Patients After an Acute, Isolated Posterior Cruciate Ligament Injury Treated Nonoperatively. American Journal of Sports Medicine. 2013 Jul;41(7):1526-1533.
  27. Schroven, W., Vles, G., Verhaegen, J., Roussot, M., Bellemans, J., Konan, S. Operative Management of Isolated Posterior Cruciate Ligament Injuries Improves Stability and Reduces the Incidence of Secondary Osteoarthritis: A Systematic Review. Knee Surgery, Sports Traumatology, Arthroscopy. 2022 May;30(5):1733-1743. doi: 10.1007/s00167-021-06723-4.
  28. Dasari, S.P., Warrier, A.A., Condon, J.J., Mameri, E.S., Khan, Z.A., Kerzner, B., Gursoy, S., Swindell, H.W., Hevesi, M., Chahla, J. A Comprehensive Meta-analysis of Clinical and Biomechanical Outcomes Comparing Double-Bundle and Single-Bundle Posterior Cruciate Ligament Reconstruction Techniques. American Journal of Sports Medicine. 2023 Nov;51(13):3567-3582. doi: 10.1177/03635465221137059.
  29. Kim, S.J., Jo, S.B., Kim, S.G., Park, I.S., Kim, H.P., Kim, S.H. Peel-off injury at the tibial attachment of the posterior cruciate ligament in children. American Journal of Sports Medicine. 2010 Sep;38(9):1900-1906.
  30. Harner, C.D., Vogrin, T.M., Höher, J., Ma, C.B., Woo, S.L. Biomechanical Analysis of a Posterior Cruciate Ligament Reconstruction. Deficiency of the Posterolateral Structures as a Cause of Graft Failure. American Journal of Sports Medicine. 2000 Jan-Feb;28(1):32-39.
  31. Dzidzishvili, L., Allahabadi, S., Allende, F., Dave, U., Poulson, T.A., Rutherford, R.P., Rubin, J., Chahla, J. Single-Bundle Autografts Outperform Single-Bundle Achilles Allograft in Posterior Cruciate Ligament Reconstruction in Terms of Posterior Tibial Translation and Clinical Outcomes, but No Differences Exist Between Double-Bundle Grafts: A Network Meta-analysis. American Journal of Sports Medicine. 2025 Dec;53(14):3528-3545. doi: 10.1177/03635465251327675.
  32. Migliorini, F., Pintore, A., Oliva, F., Eschweiler, J., Bell, A., Maffulli, N. Allografts as Alternative to Autografts in Primary Posterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-Analysis. Knee Surgery, Sports Traumatology, Arthroscopy. 2023 Jul;31(7):2852-2860. doi: 10.1007/s00167-022-07258-y.
  33. Li, J., Kong, F., Gao, X., Shen, Y., Gao, S. Prospective Randomized Comparison of Knee Stability and Proprioception for Posterior Cruciate Ligament Reconstruction With Autograft, Hybrid Graft, and γ-Irradiated Allograft. Arthroscopy. 2016 Dec;32(12):2548-2555.
  34. Ahmad, C.S., Cohen, Z.A., Levine, W.N., Gardner, T.R., Ateshian, G.A., Mow, V.C. Codominance of the Individual Posterior Cruciate Ligament Bundles. An Analysis of Bundle Lengths and Orientation. American Journal of Sports Medicine. 2003 Mar-Apr;31(2):221-225.
  35. Kennedy, N.I., Wijdicks, C.A., Goldsmith, M.T., Michalski, M.P., Devitt, B.M., Åroîn, A., Engebretsen, L., LaPrade, R.F. Kinematic Analysis of the Posterior Cruciate Ligament, Part 1: The Individual and Collective Function of the Anterolateral and Posteromedial Bundles. American Journal of Sports Medicine. 2013 Dec;41(12):2828-2838.
  36. Wijdicks, C.A., Kennedy, N.I., Goldsmith, M.T., Devitt, B.M., Michalski, M.P., Åroîn, A., Engebretsen, L., LaPrade, R.F. Kinematic Analysis of the Posterior Cruciate Ligament, Part 2: A Comparison of Anatomic Single- Versus Double-Bundle Reconstruction. American Journal of Sports Medicine. 2013 Dec;41(12):2839-2848.
  37. Yoon, K.H., Bae, D.K., Song, S.J., Cho, H.J., Lee, J.H. A Prospective Randomized Study Comparing Arthroscopic Single-Bundle and Double-Bundle Posterior Cruciate Ligament Reconstructions Preserving Remnant Fibers. American Journal of Sports Medicine. 2011 Mar;39(3):474-480.
  38. Deichsel, A., Gellhaus, F., Peez, C., Raschke, M.J., Martinovic, M., Herbst, E., Herbort, M., Fink, C., Kittl, C. A Flat Posterior Cruciate Ligament Reconstruction Restores Native Knee Kinematics, Comparable to a Double-Bundle Reconstruction — A Biomechanical Robotic Investigation. Knee Surgery, Sports Traumatology, Arthroscopy. 2025 Oct;33(10):3489-3498. doi: 10.1002/ksa.12572.
  39. Margheritini, F., Mauro, C.S., Rihn, J.A., Stabile, K.J., Woo, S.L., Harner, C.D. Biomechanical Comparison of Tibial Inlay Versus Transtibial Techniques for Posterior Cruciate Ligament Reconstruction: Analysis of Knee Kinematics and Fraft in Situ Forces. American Journal of Sports Medicine. 2004 Apr-May;32(3):587-593. doi: 10.1177/0363546503261717.
  40. McAllister, D.R., Markolf, K.L., Oakes, D.A., Young, C.R., McWilliams, J. A Biomechanical Comparison of Tibial Inlay and Tibial Tunnel Posterior Cruciate Ligament Reconstruction Techniques: Graft Pretension and Knee Laxity. American Journal of Sports Medicine. 2002 May-Jun;30(3):312-317.
  41. Weimann, A., Wolfert, A., Zantop, T., Eggers, A.K., Raschke, M., Petersen, W. Reducing the “Killer Turn” in Posterior Cruciate Ligament Reconstruction By Fixation Level and Smoothing the Tibial Aperture. Arthroscopy. 2007 Oct;23(10):1104-1111.
  42. Burns, W.C. 2nd, Draganich, L.F., Pyevich, M., Reider, B. The Effect of Femoral Tunnel Position and Graft Tensioning Technique on Posterior Laxity of the Posterior Cruciate Ligament-Reconstructed Knee. American Journal of Sports Medicine. 1995 Jul-Aug;23(4):424-430.
  43. Yoon, K.H., Kim, J.S., Park, J.Y., Park, S.Y., Kiat, R.Y.D., Kim, S.G. Comparable Clinical and Radiologic Outcomes Between an Anatomic Tunnel and a Low Tibial Tunnel in Remnant-Preserving Posterior Cruciate Ligament Reconstruction. Orthopaedic Journal of Sports Medicine. 2021 Feb 23;9(2):2325967120985153.
  44. Tachibana, Y., Tanaka, Y., Kinugasa, K., Hamada, M., Horibe, S. Sequential Changes in Posterior Tibial Translation After Posterior Cruciate Ligament Reconstruction: Risk Factors for Residual Posterior Sagging. Orthopaedic Journal of Sports Medicine. 2021 Jun 4;9(6).
  45. Petersen, W., Lenschow, S., Weimann, A., Strobel, M.J., Raschke, M.J., Zantop, T. Importance of Femoral Tunnel Placement in Double-Bundle Posterior Cruciate Ligament Reconstruction: Biomechanical Analysis Using a Robotic/Universal Force-Moment Sensor Testing System. American Journal of Sports Medicine. 2006 Mar;34(3):456-463. doi: 10.1177/0363546505281239.
  46. Tompkins, M., Keller, T.C., Milewski, M.D., Gaskin, C.M., Brockmeier, S.F., Hart, J.M., Miller, M.D. Anatomic Femoral Tunnels in Posterior Cruciate Ligament Reconstruction: Inside-Out Versus Outside-In Drilling. American Journal of Sports Medicine. 2013 Jan;41(1):43-50.
  47. Jang, K.M., Park, S.C., Lee, D.H. Graft Bending Angle at the Intra-articular Femoral Tunnel Aperture After Single-Bundle Posterior Cruciate Ligament Reconstruction: Inside-Out Versus Outside-In Techniques. American Journal of Sports Medicine. 2016 May;44(5):1269-1275.
  48. Moatshe, G., Brady, A.W., Slette, E.L., Chahla, J., Turnbull, T.L., Engebretsen, L., LaPrade, R.F. Multiple Ligament Reconstruction Femoral Tunnels: Intertunnel Relationships and Guidelines to Avoid Convergence. American Journal of Sports Medicine. 2017 Mar;45(3):563-569. doi: 10.1177/0363546516673616.
  49. Harner, C.D., Janaushek, M.A., Ma, C.B., Kanamori, A., Vogrin, T.M., Woo, S.L. The Effect of Knee Flexion Angle and Application of an Anterior Tibial Load at the Time of Graft Fixation on the Biomechanics of a Posterior Cruciate Ligament-Reconstructed Knee. American Journal of Sports Medicine. 2000 Jul-Aug;28(4):460-465.
  50. Levy, B.A., Piepenbrink, M., Stuart, M.J., Wijdicks, C.A. Posterior Cruciate Ligament Reconstruction With Independent Suture Tape Reinforcement: An In Vitro Biomechanical Full Construct Study. Orthopaedic Journal of Sports Medicine. 2021 Feb 16;9(2).
  51. Apsingi, S., Nguyen, T., Bull, A.M., Unwin, A., Deehan, D.J., Amis, A.A. Control of Laxity in Knees With Combined Posterior Cruciate Ligament and Posterolateral Corner Deficiency: Comparison of single-Bundle Versus Double-Bundle Posterior Cruciate Ligament Reconstruction Combined With Modified Larson Posterolateral Corner Reconstruction. American Journal of Sports Medicine. 2008 Mar;36(3):487-494.
  52. Kim, S.J., Kim, S.H., Chun, Y.M., Hwang, B.Y., Choi, D.H., Yoon, J.Y. Clinical Comparison of Conventional and Remnant-Preserving Transtibial Single-Bundle Posterior Cruciate Ligament Reconstruction Combined With Posterolateral Corner Reconstruction. American Journal of Sports Medicine. 2012 Mar;40(3):640-649.
  53. Mygind-Klavsen, B., Nielsen, T.G., Lind, M.C. Outcomes After Posterior Cruciate Ligament (PCL) Reconstruction in Patients With Isolated and Combined PCL Tears. Orthopaedic Journal of Sports Medicine. 2017 Apr 10;5(4).
  54. Devitt, B.M., Dissanayake, R., Clair, J., Napier, R.J., Porter, T.J., Feller, J.A., Webster, K.E. Isolated Posterior Cruciate Reconstruction Results in Improved Functional Outcome but Low Rates of Return to Preinjury Level of Sport: A Systematic Review and Meta-analysis. Orthopaedic Journal of Sports Medicine. 2018 Oct 26;6(10):2325967118804478.

 

 

Interested in More Clinical Resources? 

 

Arthroscopy Journal 

 

  1. Polypropylene Mesh Augmentation in Posterior Cruciate Ligament Reconstruction Improves Biomechanical Performance Without Additional Inflammation: A Biomechanical Study in an Animal Model
    Wenxuan Li, M.D., Yuhang Lv, M.M., Meng Wang, B.M., Jiaxin Liu, B.M., Hangzhou Zhang, M.D. 
  2. Lower Rates of Osteoarthritis Progression and Improved Knee Stability Are Observed With the Double-Bundle Versus Single-Bundle Posterior Cruciate Ligament Reconstruction Technique: A Systematic Review
    Lika Dzidzishvili, M.D., PH.D., Cameron Gerhold, B.S., Colton C. Mowers, B.S., Justin Childers, B.A., Benjamin Lack, B.A., Divesh Sachdev, B.S., Garrett R. Jackson, M.D., Andrew S. Bi, M.D., Jorge Chahla, M.D., Ph.D. 
  3. Editorial Commentary: Evidence Remains Elusive Regarding the Casual Effect of Delayed Posterior Cruciate Ligament Reconstruction on Intra-articular Injury Incidence Due to Persistent Knee Instability
    Balint Zsidai, M.D., Eric Hamrin Senorski, P.T., Ph.D., Volker Musahl, M.D., Kristian Samuelsson, M.D., Ph.D., M.Sc. 
  4. Older Age, Female Sex, Chronic Injury, and Higher Preoperative Patient-Reported Outcome Scores Predict the Failure to Achieve the Maximal Outcome Improvement Thresholds Anchored by Patients’ Willingness to Undergo Posterior Cruciate Ligament Reconstruction
    Wenbin Bai, M.D., Xi Gong, M.D., Ye Zhang, M.D., Ruirui Yin, M.D., Yiwei Zhang, M.D., Yuanhang Zhao, M.D., Jian Wang, M.D., Haijun Wang, M.D., Cheng Wang, M.D., Jianquan Wang, M.D., Weili Shi, M.D., Ph.D. 
  5. Delayed Posterior Cruciate Ligament Reconstruction, Older Age, and Higher Body Mass Index Are Associated With an Increased Prevalence of Concomitant Cartilage and Meniscal Injuries
    Wenbin Bai, M.D., Cheng Wang, M.D., Moran Zhu, Haitao Ji, Ye Zhang, M.D.,Yuanhang Zhao, M.D., Jian Wang, M.D., Haijun Wang, M.D., Xi Gong, M.D., Jianquan Wang, M.D., Weili Shi, M.D., Ph.D. 

 

Arthroscopy Techniques 

  1. All-Inside PCL Reconstruction, Double Bundle, With Internal Brace Augmentation
    Douglas L. Nestorovski, M.D., Ryan Haratian, B.A., Alvarho Guzman, B.A., Ioanna K. Bolia, M.D., Ph.D., M.S., James L. Chen, M.D., Joseph N. Liu, M.D., Frank A. Petrigliano, M.D., Alexander E. Weber, M.D., George F. Rick Hatch, M.D. 
  2. Arthroscopic Remnant Preserving 3-Portal Posterior Cruciate Ligament Reconstruction With Reverse Passage of the Graft
    Krzysztof Hermanowicz, M.D., Ph.D., Tomasz Mrozek, M.D., Adrian Goralczyk, M.D., Piotr Jancewicz, M,D., Aleksandra Dolzynska, Laura Szajwa, Julia Hermanowicz 
  3. Posterior Cruciate Ligament Reconstruction Using Flat-Tissue Grafts
    Christian Fink, M.D., Luca Farinelli, M.D., Elisabeth Abermann, M.D., Amit Meena, M.D., Robert Smigielski, M.D., Mirco Herbort, M.D. 
  4. Single-Bundle Anatomical Posterior Cruciate Ligament Reconstruction With Remnant Preservation
    Jinzhong Zhao, M.D. 
  5. Arthroscopic Primary Posterior Cruciate Ligament Repair With Suture Augmentation
    Jelle P. van der List, M.D., Gregory S. DiFelice, M.D. 

 

Arthroscopy, Sports Medicine and Rehabilitation 

 

  1. Suture Tape-Augmented Posterior Cruciate Ligament Repair Should Be Tensioned and Fixed at Approximately 100° Knee Flexion to Prevent Loss of Full Flexion
    Roger Ostrander, M.D., Steve Jordan, M.D., John Konicek, William Baldwin, M.D. 
  2. No Difference in Clinical Outcomes Between Concomitant Anterior and Posterior Cruciate Ligament Reconstruction With and Without Independent Suture Tape Augmentation
    Adam J. Tagliero, M.D., Brandon Cabarcas, M.D., Sanathan Iyer, M.S., Adam V. Daniel, M.D., John J. Jelly, M.D., Aaron J. Krych, M.D., Bruce A. Levy, M.D. 
  3. Commercially Available Guides Overestimate Socket Length During Anterior and Posterior Cruciate Ligament Socket Retrograde Drilling
    Emily R. McDermott, M.D., Michael Proffitt, Ph.D., Clayton W. Nuelle, M.D., Bjorn Chrisitan Balldin, M.D. 
  4. Stress Radiography is a Reliable Method to Quantify Posterior Cruciate Ligament Insufficiency: A Systematic Review 
    Jared Guth, M.D., Robert H. Brophy, M.D., Matthew J. Matava M.D., R. Garrett Steinmetz, M.D., Matthew V. Smith, M.D.
  5. Open Repair of Posterior Cruciate Ligament Femoral Peel-Off Lesion in Multiligamentous Knee Injuries Results in Good Outcomes
    Sunit Hazra, M.S., Soumendu Nath, M.S., Anant Kumar Garg, M.S., Sourav Ghosh, M.S., Sandip Ghosh, M.S., Mainak Chandra, M.S. 

 

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