22 studies (15 RCTs and 7 prospective cohorts) were included in this systematic review and meta-analysis to provide a comprehensive synthesis of evidence comparing anatomic double-bundle anterior cruciate ligament reconstruction (DB-ACLR) and anatomical single-bundle anterior cruciate ligament reconstruction (SB-ACLR) while accounting for the different drilling techniques applied. The results of this meta-analysis indicated that regardless of femroal drilling technique used (transtibial or independent) in SB-ACLR, DB-ACLR provided significantly greater rotational stability. The study also identified differences between SB-ACLR drilling techniques when compared to DB-ACLR, indicating that when an independent drilling technique was used, there were no significant differences in anterior laxity or IKDC scores, while the use of a transtibial drilling technique for SB-ACLR resulted in greater anterior laxity and worse IKDC objective scores in comparison to DB-ACLR.