Double-Bundle Posterior Cruciate Ligament Reconstruction Using the Rectus Femoris Graft-Superficial Layer of the Quadriceps: Surgical Technique.

Abstract

We describe a practical and reproducible technique for anatomic posterior cruciate ligament (PCL) reconstruction using a rectus femoris tendon graft in a double-bundle femoral configuration. The graft is harvested from the superficial layer of the quadriceps tendon and prepared in a Y-shaped construct, creating 2 symmetrical femoral bundles. Outside-in femoral drilling allows precise replication of the anterolateral and posteromedial bundle anatomy, whereas a single tibial tunnel is created from the anterolateral cortex to the PCL footprint under fluoroscopic and arthroscopic guidance. Notably, the graft can be harvested using a conventional tendon stripper typically used for hamstring grafts, avoiding the need for specialized instruments. Fixation is performed with interference screws, and the technique preserves hamstring integrity with minimal donor-site morbidity. This method provides a cost-effective and versatile option for double-bundle PCL reconstruction, with applicability even in resource-limited settings.