In the past 2 decades, there has been an increase in both basic science research detailing the anatomy and
biomechanics of the native posterior cruciate ligament (PCL) and outcome studies evaluating manage-
ment of the ruptured PCL. While the methodology of the latter continues to improve, results based on
the current level of evidence must be interpreted cautiously (18). The focus of many recent studies has
been double-bundle versus single-bundle reconstruction techniques. The theoretical advantage goes to
double-bundle techniques, but a clinical difference in outcome has not been consistently demonstrated (8,17).
Some biomechanical studies have reported improved control of posterior laxity with double-bundle reconstruc-
tion; however, results appear to be more dependent on tunnel position and graft tensioning (13).
In acute isolated symptomatic PCL injuries in which the posteromedial bundle and the meniscofemoral
ligament remain intact, a single-bundle augmentation procedure may be the preferred surgical technique. In
more complex PCL ruptures with associated injuries involving the posterolateral structures (PLS) or medial
collateral ligament, more benefit may be derived from double-bundle reconstruction. Again, cadaveric testing
of double-bundle PCL reconstruction has not consistently outperformed single-bundle techniques in combined
PCL/PLS injury (3). Multi-ligamentous injuries are commonly associated with PCL rupture (15), and their
management should be considered carefully in the decision to reconstruct one or both of the functionally dis-
tinct PCL bundles. However, the technical complexity of double-bundle reconstruction, the longer surgical time
required, as well as the inconclusive clinical outcome are all factors that must be weighed carefully.