The management of an ACL injury still remains controversial, and while both nonoperative treatment and ACL reconstruction (ACLR) are viable options, there is no consensus regarding the optimal treatment. Timing of ACLR can range from never to acute, and while some patients are copers, that is, patients who return to their pre-injury level without instability, many young and active patients become non-copers, and in the process risk damage to adjacent cartilage, menisci, and other intra-articular structures. Delaying ACLR is associated with a higher incident for subsequent injuries and increased risk for an irreparable meniscus. Furthermore, traditional opinion has advocated delaying ACLR to allow for the knee to decrease swelling and regain ROM to prevent arthrofibrosis. This dogma is inconsistent with current research, where acute ACLR can be performed within 48 h without increased risk of stiffness and with equivalent patient reported outcome measurements (PROMs). Additionally, from an economic perspective, early ACLR is likely to be a more cost-effective strategy, at least for the younger and active population.