The debate around the reconstruction of the anterior cruciate ligament (ACL) has been going on for many years. Articles mainly concentrate on the type of donor tissue used, the timing of the operation, the donorsite morbidity as well as patient selection. In America alone 50 000 of these procedures are performed annually, where as the figure in the RSA is 2 500 annualy. It is widely accepted by surgeons that the arthroscopical assisted ACL reconstruction for patients with torn ACL in sports which involved cutting and sidestepping like soccer, rugby etc., is the best way to restore the ACL function. Bone patella tendon bone autograft and the double loop semitendinosus I gracilis tendon are widely regarded as suitable for replacements for the torn ACL. Factors like the technique of the operation, the fixation of donor tissue to bone and the donor area morbidity are currently under severe scientific examination. A lot of criticism in the literature is directed at the bias of the subjective and objective reporting of results, as well as the patient selection. Until there is uniformity in the reporting of the results, and longterm prospective comparative studies the controversy will last Although the perfect ACL substitution has not been found, there is a lot of positive opinion that our knowledge of the treatment of ACL injuries will improve over the next decade.