Anterior Cruciate Ligament (ACL) repair versus reconstruction–which is best for surgically indicated patients with ACL tears? For the last few decades at least, the answer has largely been reconstruction. It comes as no surprise, after all, ACL reconstruction has a much larger evidence base and proven track record. Ultimately, reconstructing the ACL results in a stable tissue less prone to retear. Yet, even gold standards have room to improve. ACL reconstructions, for example, often require autograft harvesting which can mean patients are left with donor site morbidity and pain – and longer recovery times. (1-3) The non-native tissue also lacks the biological properties of the native ACL which could inhibit the recovery of proprioceptive capabilities. (1-3) The procedure also requires larger, more invasive bone tunnels which can put patients at risk of developing early onset osteoarthritis. (1-3) All things that could be avoided, or minimized, through conservative management or ACL repair. This discussion is further complicated by other factors such as tear type, age, activity level, physical therapy protocol, and a relatively new array of alternative surgical procedures – which approach benefits select patients most? In this OE Original, we explore some of the evidence comparing ACL repair to reconstruction and discuss one new approach to ACL repair, Bridge-Enhanced Anterior Cruciate Ligament Repair (BEAR), that could reignite this debate once more.