A large number of anterior cruciate ligament (ACL) reconstructions are being performed each year around the world. However the question remains: 'how perfect are current operative techniques?' Numerous techniques have been introduced to the literature, but success rates for long-term clinical outcome can still not exceed 85-90%. The global perspective on ACL reconstruction shows that more then 20 different surgical techniques are available today and that more then five different grafts are currently being used with different rehabilitation protocols and different outcome assessments. At the recently held Panther Sports Medicine Symposium, specialists in knee ligament reconstruction presented their graft choices and preferred techniques for ACL reconstruction on a global panel consisting of experts from five continents. Interestingly, about 50% of the experts were in favor of the hamstring tendons, 50% preferred the B-T-B graft, and two-thirds of the surgeons used multiple grafts. There was a discussion about several possibilities for fixation of grafts that have undergone an evolutionary process in the past two decades. Especially for hamstring tendons, we still have not yet found the perfect solution. However, talking about different grafts keeps us from addressing the real dilemma: `the perfect graft does not yet exist. This perfect graft would reproduce insertion sites and biomechanics, provide biological incorporation, and resume neuromuscular control. A large number of anterior cruciate ligament (ACL) reconstructions are being performed each year around the world. However the question remains: 'how perfect are current operative techniques?' Numerous techniques have been introduced to the literature, but success rates for long-term clinical outcome can still not exceed 85-90%. The global perspective on ACL reconstruction shows that more then 20 different surgical techniques are available today and that more then five different grafts are currently being used with different rehabilitation protocols and different outcome assessments. At the recently held Panther Sports Medicine Symposium, specialists in knee ligament reconstruction presented their graft choices and preferred techniques for ACL reconstruction on a global panel consisting of experts from five continents. Interestingly, about 50% of the experts were in favor of the hamstring tendons, 50% preferred the B-T-B graft, and two-thirds of the surgeons used multiple grafts. There was a discussion about several possibilities for fixation of grafts that have undergone an evolutionary process in the past two decades. Especially for hamstring tendons, we still have not yet found the perfect solution. However, talking about different grafts keeps us from addressing the real dilemma: `the perfect graft does not yet exist. This perfect graft would reproduce insertion sites and biomechanics, provide biological incorporation, and resume neuromuscular control. Critical components of the ACL follow-up studies presented were reviewed and abstracted. Studies should define the time period reviewed, report percentages of patients physically evaluated, note mean ages at reconstruction and follow-up, and the interval to surgery. Previous surgical procedures, meniscal and articular cartilage pathology, and postoperative rehabilitation programs should be described as well. Methods of assessment include physical examination (grading, in particular, Lachman and pivot shift), pre- and post-operative arthrometric evaluations (with stratification), functional testing, range of motion documentation (prone heel height differences), thigh girth atrophy, grading of patellofemoral crepitation, ability to return to sports, postoperative rating scales, measures of patient subjective satisfaction, and postoperative reoperations. Measures of outcome analysis (e.g., SF-36) will become commonplace in the new millennium. Radiographic analysis is important but of limited prognostic value in the short term (2-4 year) and intermediate (5-9 year) follow-up studies; however, in long-term (e.g., >10year), follow-up should provide meaningful information. Follow-up clinical and radiographic evaluations, including activity level, subjective assessment, symptoms, range of motion, laxity, functional strength, and radiographic findings were performed every 3 months in the first year and every 6 months thereafter. The results were rated by the guidelines of the International Knee Documentation Committee (IKDC). The overall final rating was determined according to the patient's subjective assessment, symptoms, ROM, and laxity. A 100-point subjective rating scale was also used for the evaluation of each patient's level of activities, function, and symptoms. Manual Lachman and anterior drawer tests and a KT1000 arthrometer were used to evaluate the anterior translation. The Cybex 340 dynamometer (Cybex, New York, New York) was used to measure thigh muscle deficit between the operative and normal knees every 3-6 months postoperatively. The peak extension and flexion torques were isokinetically measured at 180 deg/ sec. The side-to-side ratio (peak muscle torque of the involved side/peak muscle torque of the contralateral x 100) in peak muscle torque was used as the representative parameter for thigh muscle strength. To evaluate the extent of bone tunnel enlargement after ACL reconstruction, the sclerotic margins of the tunnel were measured at the widest dimension of the tunnel. The measurements were corrected for radiographic magnification and were compared with the initially drilled tunnel size. Two millimeters or more enlargement was regarded as significant tunnel expansion.