The anterolateral bundle of the PCL is the larger and stronger of the two bundles, running from the anterolateral femoral attachment to the posterior tibial insertion. Taut in flexion.
Primary restraint against posterior tibial translation at 90 degrees flexion — the dominant PCL bundle tested by the posterior drawer.
Isolated ALB PCL tears produce a positive posterior drawer at 90 degrees. Reconstruction targets the ALB using quadriceps or hamstring graft via tibial inlay or transtibial technique.
Anterolateral bundle disruption producing positive posterior drawer at 90 degrees, managed conservatively for grade I-II or reconstructed for grade III.
Tibial inlay or transtibial anterolateral bundle PCL reconstruction for recurrent posterior tibial subluxation.
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