Surgical reconstruction of the posterior cruciate ligament: current perspectives

After over a century of orthopaedic attention, injuries to the posterior cruciate ligament (PCL) continue to pose a significant management challenge. Isolated PCL tears constitute the minority of cases, with multiligament trauma (most commonly posterolateral corner injuries) predominating. Surgical reconstruction of the PCL remains technically demanding. Historical long-term outcomes have been associated with persisting knee instability and secondary degenerative arthrosis, irrespective of surgical intervention. The past two decades have witnessed a renewed focus on understanding the anatomy and biomechanics of the PCL, and its spectrum of injury. This, along with advancements in surgical technology and techniques, has heralded a renewed impetus for operative reconstruction. While there remains no clinically demonstrated difference in outcomes of double-bundle surgery over single-bundle reconstruction, many prefer a double bundle approach due to empirical data supporting its biomechanical superiority. Concomitant bony realignment in the coronal and sagittal plane should be considered where necessary. Graft reinforcement is an emerging concept that may aid in protecting the neoligament during the early healing phase. With modern approaches, there are increasing reports of more favourable short and mid-term post-operative outcomes. Despite this, most studies remain of a low level of evidence, with relatively small case series, and there is a paucity of well-designed controlled studies contrasting operative techniques.