This study evaluated the long term outcome of isolated posterior cruciate ligament (PCL) reconstruction. Thirty patients underwent surgery with hamstring tendon autograft after failing conservative management. At 10 years after surgery patients were assessed with radiographs, full IKDC examination and KT1000 instrumented testing. The mean IKDC subjective knee score was 87 out of a possible 100. Regular participation in moderate to strenuous activities improved from 26% preoperatively to 88% of patients. At 10 years endoscopic reconstruction of the PCL with hamstring tendon autograft is effective in reducing knee symptoms. Patients can expect to continue participating in moderate to strenuous activties over the long term. Osteoarthritis is observed in some patients with 18% showing some loss of joint space which compares favorably with non-operatively managed PCL injuries. This is a successful procedure for symptomatic patients with PCL laxity who have failed conservative management.