Anterior cruciate ligament reconstruction (ACLR) remains the gold standard for the treatment of ACL-deficient knees, providing reliable restoration of knee stability and function. However, ACLR, particularly autograft techniques, is associated with complications such as muscle weakness, proprioceptive deficits, and donor site morbidity. Historically, ACL primary repair was abandoned due to high failure rates, but recent studies have revived interest in ACL repair due to its potential benefits, particularly for proximal tears. Advances in the understanding of ligament healing and improved surgical techniques such as Bridge-Enhanced ACL Repair (BEAR), Dynamic Intraligamentary Stabilization (DIS), and internal bracing have shown promise in enhancing the healing potential of the native ACL. These techniques allow for improved recovery, reduced morbidity, and preservation of proprioception. However, ACL repair still has higher failure rates than reconstruction, especially in younger patients, and careful patient selection is critical for optimal outcomes. Ongoing research is needed to better define ideal candidates for receiving an ACL repair, to refine repair techniques, and to improve long-term outcomes.