Controversy continues regarding when and how best to reconstruct posterior cruciate ligament (PCL)-deficient knees. The PCL originates on the medial femoral condyle as two separate bundles and inserts on the posterior tibia below the joint line. Its key function is to prevent posterior translation of the leg in flexion. Diagnosis is best confirmed with history (blow to anterior tibia), physical examination (posterior drawer test), and imaging (stress radiographs and magnetic resonance imaging). Associated posterolateral injuries must be recognized (external rotation asymmetry). Nonoperative management has been associated with late patellofemoral and medial femoral condylar arthrosis. When operative intervention is elected, the author prefers the tibial inlay technique to avoid problems associated with the ldquo;killer turnrdquo; seen with standard arthroscopic techniques. The tibial inlay procedure is described and illustrated in this article. Postoperative management (early prone motion), complications, and preliminary results are also discussed. Early results with this technique are encouraging and will be reported in the peer-reviewed literature in the near future.
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