Treatment algorithms for posterior cruciate ligament (PCL) injury have evolved over the past two decades as the natural history of these injuries has become clearer. Whether they are isolated injuries or occur with other ligament trauma, PCL ruptures substantially alter knee kinematics. Because of the effects of PCL injury and the less than optimal results after nonsurgical treatment, new surgical techniques have been developed. Several surgical techniques currently are available for reconstruction of the PCL. Most recent reports suggest that the tibial inlay technique is the best choice for restoring posterior tibial stability. Tibial inlay PCL reconstructions can be performed through both open and arthroscopic approaches. Crucial to the outcome of these procedures is detecting all injuries to the secondary restraints, especially the posterolateral corner. Failure to recognize and treat these deficits can compromise the results of PCL reconstruction, emphasizing the need for a detailed, meticulous physical examination when PCL injuries are suspected.