ACL reconstruction, when performed correctly, has become a reliable, reproducible surgical technique with a predictable outcome. Successful results can be achieved via anatomic reconstruction with rigid fixation of a strong graft. Fixation techniques continue to evolve, with biologic fixation of graft constructs gaining popularity over the past several years. The choice of fixation should be one that provides a firm construct where accelerated rehabilitation can be achieved on all isolated primary ACL reconstructions. The results should be reproducible and, most important, the surgeon should be comfortable and confident with the fixation device. Prior to selecting a particular fixation device, the surgeon should not only be aware of any potential problems noted on biomechanical testing but also have familiarity with the proper use of the device and any clinical follow-up studies in the literature.