90 patients scheduled for arthroscopic anterior cruciate ligament reconstruction with a hamstring autograft were randomized to either double-bundle reconstruction with bioabsorbable interference screw fixation, single-bundle reconstruction with bioabsorbable interference screw fixation, or single-bundle reconstruction with metallic interference screw fixation. Patients were assessed over 10-year follow-up for graft failure rate, osteoarthritis development, knee laxity measures, and clinical/functional outcomes. After the completion of follow-up, the lowest rate of graft failure was observed in the DB group (n=1), followed by the SBM gorup (n=3) and the SBB group (n=7). The incidence of development of medial, lateral, and patellofemoral OA did not significantly differ between the three groups and results on knee laxity and patient-reported functional measures were similar between the groups.