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Anterior cruciate ligament (ACL) is a common injury and more than 100,000 ACL reconstruction procedures are performed in the United States every year. Although widely accepted and investigated, ACL reconstruction still continues to evolve and many technical issues are under debate. They mainly include: 1) graft selection, 2) surgical technique (double versus single bundle) and 3) femoral tunnel drilling in single bundle ACL reconstruction. In this review, the authors describe the indications, surgical technique and results of anatomic ACL reconstruction. The controversies are also discussed, through a recent literature review. Methodology After an ACL tear, three possible treatment options are available: 1) conservative treatment, 2) acute ACL reconstruction (within the first six weeks) and 3) chronic reconstruction. Patient’s age, profession and activity level need to be carefully evaluated to correctly plan the treatment. Conclusion To achieve good results and high satisfaction rates, correct treatment has to be tailored to meet the patient’s needs, profession, activity level, age and sports. Considering the literature review, many issues regarding ACL reconstruction are still under debate and need to be clarified with high quality studies. Introduction The anterior cruciate ligament (ACL) reconstruction is the sixth most common orthopedic procedure, with more than 100,000 surgeries performed in the United States every year1. It is widely accepted that ACL reconstruction improves stability and function of the knee and reduces the risk of chondral and meniscal injuries. In ACL deficient athletes, ACL reconstruction is the only means of achieving pre-injury level of performance. However, ACL reconstruction does not seem to protect the knee from arthrosis2, and conservative treatment can still be indicated in old and inactive patients. Although widely accepted and investigated, ACL reconstruction still continues to evolve and many technical issues are under debate. They mainly include: 1) graft selection (patellar tendon, hamstring, quadriceps tendon or allografts), 2) surgical technique (double versus single bundle) and 3) femoral tunnel drilling in single bundle ACL reconstruction (transtibial, antero-medial portal and outside-in femoral tunnel drilling). The aim of this review was to discuss the indications, techniques and results of single bundle anatomic anterior cruciate ligament reconstruction.

Single bundle anatomic anterior cruciate ligament reconstruction: Indications, technique and results