Double tunnel technique for reconstruction of the posterior cruciate ligament

Excellent biomechanical evidence supports the theory that the posterior cruciate ligament (PCL) acts primarily as two separate functional bundles, with the anterolateral or anterocentral portion of the ligament acting predominantly in flexion, and the posteromedial or posterior oblique portion of the ligament acting predominantly in extension. Because of the size of the sites of origin and insertion of the PCL, reconstruction of the ligament using a single graft necessitates that only one of these two bundles is reconstructed. Therefore, we prefer to reconstruct both bundles of the PCL, and pass two separate grafts through two separate femoral tunnels. The grafts are then passed through a single tibial tunnel, with the anterolateral/anterocentral graft being tensioned at 90° of flexion, and the posteromedial/posterior oblique graft being tensioned at 30° of flexion. The improved reproduction of PCL anatomy and biomechanics should result in a decreased incidence of late laxity in the PCL-reconstructed knee.