The ideal treatment for posterior cruciate ligament (PCL) injuries is controversial and remains an active area of orthopedic research. The indications for surgery and the ideal method of reconstruction continue to be evaluated in biomechanical and clinical studies. Recent research has provided information on the anatomy and biomechanics of the PCL, and the merits and drawbacks of the transtibial compared with the tibial inlay technique, the use of single vs double-bundle reconstruction, and different graft options for reconstruction. This review discusses important factors in the surgical treatment of PCL injuries, with attention to the most current literature on these topics.