Surgical Technique of Single-Graft Double-Bundle Posterior Cruciate Ligament Reconstruction Using the Peroneus Longus Tendon

The posterior cruciate ligament is the primary posterior stabilizer of the knee. Posterior cruciate ligament reconstruction (PCLR) has been demonstrated to improve outcomes and stability of the knee compared with conservative management. Numerous techniques are available to the treating surgeon, such as the double-bundle PCLR technique, which has biomechanical superiority over single-bundle PCLR. Residual knee laxity is decreased, native knee kinematics are better replicated, and improved subjective and objective outcomes have been reported with anatomic double-bundle PCLR. The potential disadvantages of allografts and the use of multiple grafts have created the need for the use of a double-bundle PCLR with a single autograft. Peroneus longus tendon (PLT) grafts are frequently used in anterior cruciate ligament reconstructions, and good results have been reported with their use in single-bundle PCLR. The advantages of the PLT graft include a long length, large cross-sectional area, and a simple harvesting technique. This article describes the arthroscopic technique of using the PLT for a single-graft double-bundle PCLR.