A study estimates that posterior cruciate ligament (PCL) is the largest and strongest ligament in the human knee, and the primary posterior stabilizer. Recent anatomy and biomechanical studies have provided an improved understanding of PCL function. PCL injuries are typically combined with other ligamentous, meniscal and chondral injuries. Stress radiography has become an important and validated objective measure in surgical decision making and post-operative assessment.

Posterior cruciate ligament (PCL) tears comprise 3% of outpatient knee injuries and 38% of acute traumatic knee hemarthroses. These injuries rarely occur in isolation, and up to 95% of PCL tears occur in combination with other ligament tears. With more people participating in sporting activities, these injuries will potentially increase in the future.

PCL tears are increasingly being recognized as source of morbidity and reduced function because of persistent instability, pain, impaired function and development of degenerative joint disease. The PCL is the largest and strongest intra articular ligament of the knee joint, comprising of 2 functional bundles: the larger anterolateral bundle (ALB) and the smaller posteromedial bundle (PMB).

The size of the femoral attachment of the ALB is nearly twice the size of its tibial attachment and has been reported to range from 112 to 118 mm2. The center of the femoral ALB footprint is located 7.4 mm from the trochlear point, 11.0 mm from the medial arch point, and 7.9 mm from the distal articular cartilage. Furthermore, ALB tibial attachment center is located 6.1 mm posterior to the shiny white fibers of the posterior medial meniscus root, 4.9 mm from the bundle ridge, and 10.7 mm from the champagne glass drop-off of the posterior tibia.

Of the four studies reporting Tegner scores, only one suggested slight superiority for the tibial inlay technique, with the margin being only 0.5 points higher than the transtibial technique. For all studies reviewed, Tegner scores ranged from 5.6 to 6 for the transtibial technique and 5.84 to 6.1 for the tibial inlay technique. Furthermore, there is a relative paucity between the long-term outcomes of patients who underwent a DB PCLR procedure since this treatment option is still emerging.

Future long-term studies should be performed to ultimately distinguish any significant differences between SB and DB surgical treatments and their outcomes. When restoring both these bundles on the femur with DB PCLR, knee kinematics is also restored. Variability of outcomes measurements between studies has made it difficult to determine clinical differences between SB and DB PCLR; however, recent literature has more strongly substantiated the clinical benefit of DB PCLR over SB technique.

In future study, long-term outcomes studies are needed as the treatment of PCL tears advances.