Anterior cruciate ligament (ACL) tears are one of the most common serious sports injuries. This injury can result in an unstable knee, causing meniscal tears and articular cartilage degeneration. In this article, we outline our basic approach to a patient with an ACL injury, including preoperative evaluation, patient selection, operative technique, and rehabilitation principles. Also, we identify critical factors in ACL reconstruction as well as potential pitfalls and techniques to manage them.