Basic principles for surgical reconstruction of the PCL in chronic posterior knee instability

This article describes the various options which are available for posterior cruciate ligament (PCL) reconstruction in a chronic situation. On the femoral side, one- or two-bundle grafts may be used. In laboratory conditions, 2-bundle reconstruction makes it possible to mimic more closely the biomechanics of the native PCL. However, until now there is no clear-cut clinical evidence that 2-bundle reconstruction leads to a better outcome than the 1-bundle one. On the tibial side, either a tunnel or an inlay technique can be used. The advantages and drawbacks of both techniques are still subject to debate. The results of the laboratory tests are currently in favour of the inlay fixation; however, again, the clinical issue remains to be established. In any case, proper PCL graft positioning is the key issue for a successful reconstruction. Finally, in combined posterior and postero-lateral instabilities it is necessary to correct all the components of the instability and to perform a high tibial valgus osteotomy in the case of varus alignment.