Historically, results of direct ACL repair are poor. As such, it has been viewed as a substandard surgical option in comparison to ACL reconstruction, the modern gold-standard approach. However, ACL reconstruction is not without its flaws, and as technology and techniques have advanced, the idea of ACL repair has reemerged. Coming to us from Tripler Army Medical Center, Drs. Christian Cruz and Craig Bottoni share their results with ACL repair in their military population. Like studies from the past, the failure rate was high at 26%. However, those that succeeded had good to excellent results in an average return to full duty time that beats what is expected with ACL reconstruction. Drs. Cruz and Bottoni share their experience with this active population and why ACL repair may make sense in certain situations as well as when to avoid it.