Arthroscopic reconstruction of the anterior cruciate ligament (ACL) with a bone-patellar tendon-bone graft in the press-fit technique is an efficient procedure, which provides high primary stability without use of implants and thus ensures early functional rehabilitation. The procedure is based on graft harvest with an oscillating hollow saw, which allows collection of cylindrical bone blocks. Femoral fixation using a template and file has been standardized to an extent that ensures secure press-fit fixation. Tibial anchorage is achieved by refilling the tibial tunnel with the bone cylinder removed previously. Primary stability is at least equivalent to that achieved with interference screw or staple fixation, and has been evaluated in a pull-out study in ovine knees. Two major problems encountered with revision procedures--metal removal or tunnel enlargement--may be avoided effectively. In a prospective study of 32 patients, postoperative computed tomography (CT) evaluation after three months showed presence of cancellous bone material inserted into the tibial tunnel. Postoperative tunnel enlargement seen frequently with other procedures can be avoided in almost all knees. Revision procedures after press-fit fixation can be done without problems. This procedure provides a cost-efficient alternative for reconstruction of the ACL, because it does not require implants.