Significant advancements have been made in our understanding of rupture of the anterior cruciate ligament (ACL) and its reconstruction in the last decade. Recent studies have identified risk factors for ACL reconstruction graft failure such as younger patient age, increased activity level, nonanatomic tunnel placement, and the use of allograft. Among these, one of the most easily modifiable risk factors is graft choice. It is essential for the surgeon to be able to choose the graft he will use, taking into account the mechanical and biological elements and the patient’s expectations. So, this choice must be “à la carte.” It is important to take in account all the aspect of the laxity in order to correct the anterior laxity and peripheral laxity. The purpose of this chapter is to provide an up-to-date understanding of the current ACL graft reconstruction options. The indications, advantages, and disadvantages of the different ACL reconstruction graft options available will be discussed.