The keys to successful posterior cruciate ligament reconstruction are to identify and treat all pathology, use strong graft material, accurately place tunnels in anatomic insertion sites, minimize graft bending, use a mechanical graft tensioning device, use primary and back-up graft fixation, and employ the appropriate postoperative rehabilitation program. Adherence to these technical points results in successful single and double bundle arthroscopic transtibial tunnel posterior cruciate ligament reconstruction documented with stress radiography, arthrometer, knee ligament rating scales, and patient satisfaction measurements. Oper Tech Sports Med 17:175-193 (C) 2009 Elsevier Inc. All rights reserved.