Sixty-four patients with anterior cruciate ligament (ACL) injuries who underwent reconstruction were evaluated at long-term follow-up after being randomized to receive an anatomic double-bundle (DB) ACL reconstruction (n=35) or an anatomic single-bundle (SB) ACL reconstruction (n=29). The outcomes of interest was the presence of positive pivot-shift test results at long-term follow-up, knee laxity measurements using the KT-1000 arthrometer and manual Lachman test, range of motion, single-leg-hop test performance, Lysholm knee scores, Knee Injury and Osteoarthritis Outcome Score (KOOS), Tegner activity scale scores, and radiographic evidence of osteoarthritis. Outcomes were assessed at a median follow-up of 173 months (approximately 14 years). Overall, the results of the study revealed no statistically significant differences between the DB and SB groups in pivot-shift tests, knee laxity, functional outcomes, activity levels, or radiographic osteoarthritis. These findings suggest that anatomic double-bundle reconstruction does not provide long-term clinical or radiographic advantages over the single-bundle technique.