Operative management of an acute anterior cruciate ligament (ACL) rupture may be required in young and active patients to stabilize the knee and return patients to desired daily activities. ACL reconstruction should be performed anatomically. The majority of studies show no differences between anatomic single-bundle and double-bundle ACL reconstruction with respect to patient-reported outcome scores. Double-bundle reconstruction may provide superior knee joint laxity measurements compared with the single-bundle technique. Following ACL reconstruction, the age and activity level of a patient are predictive of his or her time of return to sports and reinjury. Concomitant meniscal and/or cartilage damage at the time of surgery, in addition to a persistent knee motion deficit, are associated with the development of osteoarthritis after ACL reconstruction.