116 patients with a chronic anterior cruciate ligament (ACL) rupture and scheduled for an arthroscopic ACL reconstruction were randomized to receive preparation of the femoral tunnel via an anteromedial technique or a transtibial technique. Outcomes of interest included anatomical outcomes, bio-mechanical outcomes, the International Knee Documentation Committee (IKDC) subjective score, the Lysholm score, and incidence of graft failure. Follow up was performed up to 2 years post-operation. Results from this study found no significant differences between the anteromedial and transtibial groups in the IKDC subjective score and Lysholm score. Femoral tunnel length and graft angulation in the sagittal and coronal planes were significantly smaller in the anteromedial group compared to the transtibial groups. Absolute improvement in internal rotation was significantly greater in the anteromedial group compared to the transtibial group. The incidence of graft rupture was similar between the two groups.