Twenty-five randomized controlled trials including 2,170 patients with anterior cruciate ligament (ACL) injuries were included in this systematic review and meta-analysis comparing bone-patellar tendon-bone (BPTB) autograft versus hamstring tendon (HT) autograft, single-bundle versus double-bundle HT autograft, and metal screws versus bioabsorbable screws. Pooled outcomes of interest included revision rates, graft failure, infection, Lysholm scores, and IKDC scores. The results indicated no significant differences between BPTB and HT autografts overall. However, double-bundle HT autograft showed superior outcomes compared to single-bundle in several parameters, and bioabsorbable screws performed better than metal screws in functionality and failure rates. These findings suggest that double-bundle HT autografts and bioabsorbable screws may provide better outcomes in ACL reconstruction.