Antegrade tibial tunnel technique for posterior cruciate ligament reconstruction

Posterior cruciate ligament (PCL) reconstruction remains a difficult procedure even in experienced hands because there is a lack of consensus regarding the most reliable and least technically challenging technique. The commonly used retrograde anteromedial tibial tunnel leads to excessive angulation at the posterior tibia and risks catastrophic neurovascular complications. We present a technique of drilling the transtibial PCL tunnel in an antegrade fashion through a posteromedial portal. This technique offers the advantage of an anterolateral route to reduce graft angulation, as well as drilling away from the important posterior neurovascular structures.