Anatomical and Biomechanical Considerations of the PCL

Abstract

This article discusses the anatomy and biomechanics of the posterior cruciate ligament (PCL) and PCL reconstructions and their implications for clinical management of PCL injuries. The PCL consists of two functional components, the anterolateral and posteromedial, based on their reciprocal tensioning patterns. The anterolateral has been the focus of single-bundle PCL reconstructions. Recent biomechanical studies have indicated that the posteromedial bundle also plays an important role, and double-bundle PCL reconstructions have also been proposed. The PCL works closely with the posterolateral structures in providing posterior knee stability. The effects of several surgical variables, including graft fixation, associated injuries, and tunnel placement, that can significantly affect the outcome of PCL reconstruction are discussed. With improved knowledge of the PCL, new reconstructive techniques are being developed, offering the potential of more closely replicating the anatomy and biomechanics of the normal PCL and improving clinical outcomes of PCL injuries.