Purpose <p>The use of quadriceps tendon (QT) autograft is on the rise owing to its specific attributes, such as predictable size, lower graft failure rate, and less donor site morbidity. The hypothesis for the current study is that ACL reconstruction using QT autograft results in better clinical outcomes than hamstrings tendon (HT).</p> Methods <p>Patients underwent a single-bundle, all-inside ACL reconstruction after being randomized into QT and HT groups. At 12&#xa0;months, objective outcomes (Lachman test, anterior drawer test, pivot shift test, and side-to-side anterior translation measurement with KT-1000) and subjective outcomes (Lysholm and KOOS scores) were evaluated, along with donor site morbidity and graft failure.</p> Results <p>Sixty-nine patients (QT: 33, HT: 36) were included in the final analysis. At 12&#xa0;month follow-up, a negative Lachman test was found in 72.7% of cases in the QT group and 41.6% in the HT group (<i>p</i> = 0.04). Positive pivot shift was more frequent in the HT group (13.9% vs. 0%, <i>p</i> = 0.27), while KT-1000 showed greater anterior translation in the HT group than QT (3.77 ± 2.01 vs. 2.73 ± 1.64&#xa0;mm, <i>p</i> = 0.23). Lysholm (92.4 vs. 88.2, <i>p</i> = 0.008) and KOOS (94.1 vs. 89.6, <i>p</i> = 0.01) scores were higher in the QT group. The only case of graft failure occurred in the HT group, which also had more sensory hypoesthesia (30.5%), while one patient in the QT group developed stiffness requiring arthrolysis.</p> Conclusion <p>Quadriceps tendon autograft in ACL reconstruction offers superior translational stability and reduced donor site morbidity, with comparable PROMs and a trend toward improved rotational stability.</p> CTRI registration number <p>CTRI/2023/07/055894.</p> Evidence Level <p>Level 1, Randomized Controlled Study.</p>