Anterior cruciate ligament integrity has a crucial role in chondro-meniscal protection. Early reconstruction prevents persistent instability which may injure these intra-articular structures. Graft options are vast with an increased interest in quadriceps autograft as the donor source. Hamstring autograft still remains the most popular graft option. Different techniques have evolved over the last decade, all of which have aimed for a more anatomical reconstruction. Single-bundle reconstruction is by far more popular; however, recent evidence has demonstrated benefits with double-bundle reconstruction. Surgical techniques are described. The anterolateral complex has become the subject of great debate over the last 5 years with recent “rediscovery” of the anterolateral ligament. Anterolateral tenodesis and anterolateral ligament reconstruction both have advantages and disadvantages, both of which are discussed. Outcomes of ACL reconstruction directly correlate with the preservation of the menisci. Rehabilitation after ACL reconstruction is critical to prevent the risk of re-rupture.