Anterior cruciate ligament (ACL) injuries sequalae lead to functional impairments and long-term problems, including osteoarthritis. Standard current techniques of ACL reconstruction rely upon autografts, allografts, and synthetic grafts; these come with limitations to it, such as risks from graft failure, slow healing, and incomplete integration with host tissues. Biological augmentation in ACL repair offers a viable method for improving graft healing and integration by incorporating biological agents such as growth factors, platelet-rich plasma (PRP), stem cells, and scaffolds. This chapter explores the current biological augmentation options, their roles at different stages of ACL healing, and their impact on clinical outcomes. Also deals with the current challenges, limitations, and future directions for biological augmentation in ACL reconstruction. Further research is needed to optimize these techniques and standardize clinical protocols in its application.