Objective To review the research on tibial tunnel positioning techniques in posterior cruciate ligament (PCL) reconstruction to provide references for clinical practice. MethodsRelevant literature on tibial tunnel positioning techniques in PCL reconstruction were extensively reviewed, and summarized. Their advantages, disadvantages, and clinical outcomes were compared. ResultsThe position of the tibial tunnel is crucial to the prognosis of PCL reconstruction. The commonly used tibial tunnel positioning techniques include transtibial anteromedial anatomical reconstruction, transtibial anterolateral anatomical reconstruction, Inlay technique, and modified tibial low tunnel reconstruction. Recent studies have shown that there is no significant difference in clinical function scores between anterolateral and anteromedial reconstructions, but the former is associated with greater postoperative posterior tibial translation, which may lead to poor knee joint stability in the long-term follow-up. Compared with other techniques, the Inlay technique is more invasive and is generally not the first clinical choice. In contrast to anteromedial reconstruction, modified tibial low tunnel reconstruction can reduce graft wear. But, studies have demonstrated no significant difference in clinical outcomes between the two techniques. In addition, the modified tibial low tunnel reconstruction is a non-anatomical reconstruction method. Studies have indicated that the degree of posterior tibial translation after non-anatomical reconstructions is greater than that after anatomical reconstruction. Whether the knee joint stability can be guaranteed after non-anatomical reconstruction remains unclear, so the advantages of this technique need to be further investigated. Conclusion Different tibial positioning techniques have their own merits and demerits. At present, there is no clear evidence that any technique has absolute advantages. Surgeons should make a choice based on their own specific conditions and the patient’s specific situation.