19 randomized controlled trials were included in this meta-analysis and systematic review comparing outcomes between four-strand hamstring tendon autografts and patellar tendon autografts at a minimum follow-up of 2-years after anterior cruciate ligament reconstruction. Pooled analyses demonstrated no significant differences between graft choices in re-rupture rate, objective and subjective tests of knee laxity/stability, and patient-reported functional measures. Outcomes which demonstrated a significant difference between grafts were the incidence of anterior knee discomfort and the incidence of discomfort during kneeling, both of which were significantly lower among groups which received the four-strand hamstring tendon autograft compared to patellar tendon autograft.