One hundred sixty-seven patients with acute ACL rupture were randomized to receive either early ACL reconstruction (n=85) or rehabilitation with the option for delayed ACL reconstruction after three months (n=82). The primary outcome was patients’ perceptions of symptoms, knee function, and ability to participate in sports, assessed using the International Knee Documentation Committee (IKDC) score over a 24-month period. Secondary outcomes included the Knee Injury and Osteoarthritis Outcome Score (KOOS), Lysholm score, return to pre-injury sporting level, knee instability (giving way), and patient satisfaction. After two years, the early ACL reconstruction group showed a significantly better IKDC score, but the clinical relevance of this difference is uncertain. At three months, the rehabilitation group had a significantly better IKDC score, but by nine months, the advantage shifted toward the early ACL reconstruction group. Half (50%) of the rehabilitation group eventually required delayed reconstruction. Overall, early ACL reconstruction led to small but statistically significant improvements in knee function at two years, though non-operative treatment was successful for half of the patients.