Techniques for the repair and reconstruction of the anterior cruciate ligament (ACL) have advanced rapidly in the last decade. The procedure for ACL reconstruction and its equipment have become progressively sophisticated from what was once an open surgery requiring dislocation of the patella to the point where ACL reconstruction surgery can now be performed endoscopically through one small incision. By avoiding a superior / lateral incision through the quadriceps muscle, the endoscopic technique provides the advantages of reduced soft tissue morbidity, reduced pain and improved cosmetic appearance for the patient, and reduced costs due to the fact that the procedure can be performed on an outpatient basis. However, the success of the procedure in restoring normal stability and function to the knee is still based on the variables of graft type, placement, tension, and fixation, as well as postoperative rehabilitation. Numerous studies have provided valuable information regarding advancements in the surgical technique and rehabilitation for ACL reconstruction surgery. Regardless, variable success rates continue to be reported. For failures occurring within the first six months after surgery, graft fixation failure has been shown to be the major cause.