This study compared the differences in clinical outcome between an endoscopic (67 of 70) and two-incision (41 of 49) technique used to reconstruct tom anterior cruciate ligaments (ACL) using a double-looped semitendinosus and gracilis (DLSTG) graft. In both techniques, the graft was placed without roof impingement, the looped end of the graft was fixed around a post with bone compaction, and the free ends were fixed with either double staples or a soft tissue washer(s). No graft required suture fixation. The postoperative treatment featured an aggressive rehabilitation protocol without a brace, and allowed unrestricted sports participation 4 months after reconstruction. Age, sex distribution, duration from injury to surgery, and preoperative laxity were not significantly different between treatment groups. The operative time for the endoscopic technique averaged 48 minutes less than the two-incision technique. There were no significant differences in thigh circumference, knee extension, stability, and the single leg hop test between the two treatment groups at 4 and 24 months. Ninety-one percent of the knees in the endoscopic group and 90% in the two-incision group had less than a 3 mm increase in anterior translation compared with the normal knee using the manual maximum test (KT-1000) and had either a normal or near normal knee (IKDC score) at 2 years. A second surgery for removal of painful, prominent hardware was required in 21% of the subjects in the endoscopic group and 12% of the subjects in the two-incision treatment group. Patients preferred the endoscopic technique because the result was more cosmetic and aggressive rehabilitation could be accomplished without the assistance of a physical therapist. Unfortunately, objective stability could not be restored in about 10% of knees with either technique. Reoperation for removal of prominent staples and washers continues to be the primary source of postoperative morbidity.