Double-Bundle Posterior Cruciate Ligament Reconstruction With a Bifid Bone-Patellar Tendon-Bone Allograft

The treatment of posterior cruciate ligament (PCL) injuries remains controversial. The ideal choice of graft and reconstructive technique remains uncertain. A bifid bone-patellar tendon-bone allograft is described that is suitable for either arthroscopic transtibial tunnel or open tibial inlay reconstruction of the posterior cruciate ligament. This graft closely recreates the anatomic configuration and size of the native posterior cruciate ligament. Testing of this graft versus a single bundle construct showed improved biomechanical performance in a tibial inlay PCL reconstruction. When posterior cruciate ligament reconstruction is indicated, a double-bundle reconstruction effectively restores normal knee kinematics. We describe our clinical experience with this technique for PCL reconstruction with our active-duty military population.