The goal of this prospective study was to determine how objective measurements affect the overall subjective evaluation of recovery after anterior cruciate ligament (ACL) reconstruction and to evaluate the effects of graft material, residual instability and sporting activity on patient satisfaction. Ninety-seven patients with unilateral ACL injuries whose ACL was reconstructed using either a multi-strand semitendinosus (ST) graft or a central-third bone-patellar tendon-bone (BTB) graft were followed for an average of 30 months. An "overall subjective recovery score" was derived from the patients' evaluation of function of the operated knee as a percentage of the unoperated knee. The mean overall subjective recovery score at follow-up was 80% (range, 20% to 100%). This study strongly suggested that integrity of the knee extension mechanism, that is, good recovery of knee extension strength with achievement of full extension and no problems in the patellofemoral joint, is the most important factor in patient satisfaction after ACL reconstruction.