The efficacy of ACL reconstruction procedures to improve function in symptomatic ACL-insufficient knees has been well established. Initial satisfactory results utilizing patellar tendon autografts were compromised to varying extent by harvest site morbidity. In an attempt to reduce harvest site morbidity, other autogenous graft sources have been used as ACL substitutes. Several studies now exist comparing results of ACL reconstruction with quadrupled hamstring grafts and patellar tendon grafts and show no significant subjective differences. Successful reconstruction utilizing any appropriate graft is dependent on the adherence to principles and details of graft harvest and preparation, tunnel placement, fixation, and rehabilitation. In this article, the technique specific to ACL reconstruction with double semitendinosus and gracilis tendons utilizing Endobutton femoral fixation is discussed as well as potential complications of the procedure.