Ninety-eight patients with for anterior cruciate ligament (ACL) rupture were randomized to receive a quadrupled semitendinosus (ST-only) graft (n=49) or a doubled semitendinosus–gracilis (ST/G) graft (n=49); one ST-only patient was converted intra-op and excluded. The primary outcome was IKDC-Subjective score. Secondary outcomes included KOOS subscales, Tegner Activity Score (TAS), KT-1000 side-to-side laxity, Lachman and pivot-shift grades, sports/activity participation, and need for secondary surgery (including revision). Outcomes were assessed pre-op, 2 years, and again at a median of 8 years (range 5–10). Overall, the results of the study revealed no between-group differences at long-term follow-up for IKDC (ST 81.7 vs ST/G 82.1; p=0.93), instrumented or clinical stability, KOOS subscales, or revision rates; however, cyclops removal was more frequent with ST/G (p=0.014). Both groups showed large, durable improvements from baseline. These findings suggest ST-only grafts with adjustable-loop fixation perform comparably to traditional ST/G constructs at 5–10 years.