The posterior cruciate ligament (PCL) is recognized to be the main posterior stabilizer of the knee. PCL injuries are most commonly associated with concurrent ligament injuries and also with a high prevalence of chondral and meniscal injuries. Recent evidence of the accuracy of the stress radiographs as an objective diagnostic tool has improved assessment of surgical indications and postoperative assessment. Acute, isolated PCL injuries (grades I and II) can be treated non-operatively. However, in cases of acute grade III PCL injuries or when concurrent multiligament injuries or repairable meniscal body/root tears are present, surgery is indicated. Anatomic single-bundle PCL reconstruction (PCLR), focusing on reconstruction of the larger anterolateral bundle, is the most commonly performed procedure. Owing to the residual posterior and rotational tibial instability after a single-bundle reconstruction procedure and the inability to restore normal knee kinematics, an anatomic double-bundle PCLR has been proposed in an effort to recreate the native PCL footprint more closely and to restore normal knee kinematics. The purpose of this article is to review the specific principles of PCL anatomy, biomechanics, injury diagnosis and treatment options, with a focus on arthroscopic double- bundle PCLRs.
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