Posterior cruciate ligament (PCL) injuries, typically resulting from high-energy trauma, present significant challenges in orthopaedic sports medicine. While many isolated PCL tears are managed conservatively, the growing number of posterior cruciate ligament reconstructions (PCLR) highlights the necessity of preventing long-term instability and arthritis. Failure rates of PCLR range between 2.5% and 30%, often due to unaddressed posterolateral corner injuries, malpositioned tunnels, and tunnel widening. Revision PCLR, although complex, can successfully restore knee stability when executed with meticulous planning. This chapter examines the key aspects of revision PCLR, including indications, preoperative assessment, and surgical strategies. Persistent functional instability necessitates surgical intervention to correct posterior tibial translation and rotational laxity. Comprehensive imaging (MRI, CT) is essential to assess tunnel positioning, graft integrity, and concurrent knee pathology. Ruling out infection through fluid analysis and inflammatory markers is critical. Successful revision relies on addressing associated ligament injuries, correcting malalignment, and managing tunnel complications. The choice of graft—autograft or allograft—and fixation technique must be customised to each case. In complex scenarios, staged procedures, bone grafting, or osteotomies may be required. Single-bundle and double-bundle techniques are employed based on anatomical considerations and previous surgical approaches. Emerging techniques, such as tibial inlay procedures for patients with poor bone stock, are gaining traction, along with improved fixation methods to enhance graft stability. Potential complications include neurovascular injury, persistent instability, and arthrofibrosis, emphasising the need for precise surgical execution and structured rehabilitation. Despite its challenges, revision PCLR remains a viable solution for restoring knee function and enabling patients to return to desired activity levels, significantly improving their quality of life.