Digital ExclusiveAnatomy and Biomechanics of the Posterior Cruciate Ligament and Their Surgical ImplicationsArthur, Jaymeson R. MD; Haglin, Jack M. BS; Makovicka, Justin L. MD, MBA; Chhabra, Anikar MD, MSAuthor Information Department of Orthopaedic Surgery, Mayo Clinic Arizona, Phoenix, AZ Disclosure: A.C. has received consulting fees from Arthrex, Trice Medical, and Zimmer Biomet and educational support from Smith & Nephew and Desert Mountain Medical. The remaining authors declare no conflict of interest. Reprints: Anikar Chhabra, MD, MS, Mayo Clinic Arizona, Orthopedic Surgery, 5777 E Mayo Blvd, Phoenix, AZ 85054. Online date: December 31, 2019 Sports Medicine and Arthroscopy Review: March 2020 - Volume 28 - Issue 1 - p e1–e10 doi: 10.1097/JSA.0000000000000267 Buy Metrics Abstract Knowledge and understanding of the complex anatomy and biomechanical function of the native posterior cruciate ligament (PCL) is vitally important when evaluating PCL injury and possible reconstruction. The PCL has important relationships with the anterior cruciate ligament, menisci, tibial spines, ligament of Humphrey, ligament of Wrisberg, and the posterior neurovascular structures. Through various experimental designs, the biomechanical role of the PCL has been elucidated. The PCL has its most well-defined role as a primary restraint/stabilizer to posterior stress and it seems this role is greatest at higher degrees of knee flexion. The natural history of high-grade deficiency leads to increased contact pressures and degeneration of both the medial and patellofemoral compartments. There is still considerable debate regarding whether high-level athletes can return to sport at the same level with conservative treatment of a high-grade PCL tear, and whether greater laxity in the knee correlates with decreased subjective and objective outcomes. Poor surgical outcomes after PCL reconstruction have been attributed to many factors, the most common of which include: additional intra-articular pathology, poor fixation methods, insufficient knowledge of PCL anatomy, improper tunnel placement, and poor surgical candidates. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.