All-Arthroscopic Tibial Inlay Double-Bundle Posterior Cruciate Ligament Reconstruction

Posterior cruciate ligament (PCL) injury is less frequent than anterior cruciate ligament rupture. Nonetheless, the correct management of PCL ruptures is crucial for restoration of normal knee joint function and ultimately in the prevention of knee joint arthrosis. Multiple surgical techniques exist for the reconstruction of the PCL including transtibial drilling, open tibial inlay, and arthroscopic tibial inlay. Furthermore, graft-type choices are present for PCL reconstruction (PCL-R) including multiple autograft and allograft options in addition to single-bundle and double-bundle options. The goal of this chapter is to outline the senior author’s preferred combination of graft choice and surgical technique, the double-bundle all-arthroscopic tibial inlay PCL-R. A literature-driven discussion highlights the important features of this technique and illustrates why we advocate for this surgical technique as the optimal approach to restoring normal knee kinematics following injury to the PCL.