Successful posterior cruciate ligament (PCL) reconstruction is challenging because of the complex structures and difficult reconstruction techniques that are required. The reported results have been inconsistent. Variables that affect the results of surgery to restore PCL function include combined associated ligaments injury, difficulty to duplicate PCL anatomy, wide variation in broad femoral insertion footprint, difficulty in accurate placement of the transtibial tunnel, tunnel erosion, high internal graft stresses and graft elongation. The outcome of conservative treatment of isolated PCL injuries with mild or moderate laxity is generally acceptable. However, more severe straight posterior laxity or combined injury patterns usually lead to a worse prognosis. Surgical reconstruction for PCL can achieve satisfactory results for most patients if adequate surgical principles and techniques are followed. Recent studies on the anatomy and the biomechanics of PCL have led to a better understanding of its biomechanical properties for the reconstruction. It has been generally agreed that surgical reconstruction is indicated for symptomatic severe posterior knee instability and multiple ligament injuries for better functional recovery after PCL injuries. Accepted surgical techniques for the treatment of PCL tears include primary repair for PCL avulsion fracture, as well as open or arthroscopic reconstruction using the transtibial or tibial inlay technique. Controversy continues over the choice of graft tissue, one or two bundle reconstruction, location of tunnel placement, knee position when securing the graft, and fixation technique. From the accumulated clinical experience and surgical concepts in clinical practice, we have developed various surgical techniques to improve the outcomes of reconstruction.