Surgical techniques, including bone tunnel drilling and graft types, are primarily based on the surgeon’s preferences. Various techniques are employed for femoral and tibial tunnel preparation, such as the inside-out and outside-in approaches. For the femoral tunnel, the inside-out technique can be executed using either a transtibial or anteromedial portal technique, with the anteromedial technique emerging as the gold standard. This chapter will cover the advantages and disadvantages of different tunnel drilling methods. Regardless of the chosen surgical technique, the goal is to achieve an anatomical femoral and tibial tunnel placement, as most failures in anterior cruciate ligament (ACL) reconstruction are attributed to improper tunnel positioning. The choice of graft remains a topic of debate in ACL reconstruction. The three most commonly used grafts are hamstring tendon with or without gracilis tendon, patellar tendon, and quadriceps tendon grafts. Alternatives include the peroneus longus split tendon and allografts. Each graft type has its own advantages and disadvantages, which will be discussed in this chapter. Graft selection may depend on the complexity of the knee injury and patient demands. For instance, patients who frequently kneel or experience high patellofemoral loading may not be ideal candidates for a bone-patellar tendon-bone (BTB) graft. Additionally, patients with concomitant medial collateral ligament (MCL) injuries should avoid hamstring grafts to minimize additional medial instability. Current literature remains inconclusive on optimal choice, as no graft has shown clear superiority.