Eighty patients undergoing anterior cruciate ligament reconstruction (ACLR) were randomized to receive either a bone marrow aspirate concentrate (BMAC; n=40) or a standard ACLR procedure (n=40). The primary endpoint of this trial was magnetic resonance imaging (MRI) intensities at 3 and 9 months, postoperatively. Patient-reported outcomes such as the International Knee Documentation Committee (IKDC), Knee Injury and Osteoarthritis Score for Joint Replacement (KOOS-JR), and Tegner scores were assessed. Other outcomes such as range of motion were also assessed at 6 weeks, 3, 6, 9, and 12 months post-operatively. Patients in the BMAC group showed greater MRI signal intensity scores at 3 months and significantly better IKDC scores at 9 months follow-up, compared to the sham treatment group.