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Anterior cruciate ligament surgery is a frequently performed orthopaedic surgical procedure in the United States. However, posterior cruciate ligament (PCL) injuries are less common in this country and the orthopaedic surgeon is correspondingly less experienced in PCL examination, diagnosis, and surgical reconstruction. Studies indicate that acute PCL injuries are related to geographic region, frequency of blunt trauma, and the population density of orthopaedic surgeons. It is estimated that relatively few orthopaedic surgeons perform PCL surgery when compared with anterior cruciate ligament surgery, and complications may result from lack of experience in diagnosis, surgical techniques, and postoperative care. PCL reconstruction is technically demanding surgery. Complications encountered with this surgical procedure include failure to recognize associated ligament injuries, neurovascular complications, persistent posterior sag, osteonecrosis, loss of knee motion, anterior knee pain, and fractures. A comprehensive preoperative evaluation, including an accurate diagnosis, a well planned, and carefully executed surgical procedure, and a supervised postoperative rehabilitation program, will help to reduce the incidence of these complications.