Complications Related to Arthroscopic Isolated Posterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis of 4162 Patients

Background: Posterior cruciate ligament (PCL) reconstruction (PCLR) is increasingly performed for mid-substance tears, but complications after isolated PCLR remain poorly characterized. Purpose: To identify the complication profile of isolated arthroscopic PCLR. Study Design: Systematic review and meta-analysis; Level of evidence, 4. Methods: Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, databases were searched. Adult studies of isolated mid-substance PCLR reporting at least 1 postoperative complication were included. Pooled proportions and 95% CIs were calculated using random-effects models. A quantitative synthesis of data was conducted to compare complication rates between single- and double-bundle reconstructions and between autograft and allograft types. Results: A total of 65 studies comprising 4162 patients met the inclusion criteria. The overall complication rate was 14.8% (n = 616). The most frequent postoperative complications were persistent postoperative pain (4.2% [95% CI, 2.3%-6.6%]), residual posterior laxity (4.1% [95% CI, 2.4%-6.2%]), and arthrofibrosis (3.1% [95% CI, 1.8%-4.8%]). Structural complications occurred at lower rates, including tunnel enlargement (2.5% [95% CI, 0.5%-5.8%]), graft failure or rupture (1.7% [95% CI, 0.8%-2.8%]), and postoperative osteoarthritis (2.2% [95% CI, 1.2%-3.6%]). Reoperations remained infrequent, with nonrevision reoperations at 3.4% (95% CI, 1.8%-5.4%) and revision PCLR at 1.1% (95% CI, 0.7%-1.6%). All other complications, including infection, venous thromboembolism, vascular injury, neurologic symptoms, hardware failure, and conversion to arthroplasty, were reported with weighted proportions <1%. Subgroup analyses showed no statistically significant differences by bundle type (single vs double) or graft selection (autograft vs allograft). However, these pooled results should be interpreted with caution, given the heterogeneity across studies. Conclusion: Isolated arthroscopic PCLR demonstrates a pooled complication rate of 14.8%, with persistent pain, residual posterior laxity, and arthrofibrosis being the most frequently reported complications. Major complications were uncommon in the available literature. Subgroup analysis showed no statistically significant differences by the number of bundles reconstructed or by the use of an autograft or an allograft.