Objective To evaluate the clinical results of reconstruction of the posterior cruciate ligament by implanting the middle one third of patellar tendon graft under arthroscope. Methods Twelve patients with the posterior cruciate ligament injury reconstructed with middle one third of bone-patellar tendon-bone graft through an anterior approach under arthroscope were reviewed. Results The average follow up period was 17.3 months. The Larson score rose from 60.7 points to 93.4 points. The Lysholm score rose from 55.0 points to 91.6 points. All patients had positive posterior drawer test and positive Lachman test preoperatively,while only 2 patients had slight positive posterior drawer test and one had slight positive Lachman test at the latest follow up study. Conclusion Under direct visulization of arthroscope, one can accurately locate the anatomic insertion of the PCL, drill holes and transplant tissue grafts. Without capsulular incision, this technique has the advantages of less trauma and lower incidence of adhesion.