22 studies including 14 randomized controlled trials were selected for this meta-analysis comparing the use of bone-patellar-tendon-bone autografts to four-strand hamstring tendon autografts in anterior cruciate ligament (ACL) reconstruction. The purpose of this study was to determine if there were any significant differences in clinical, stability, and mortality outcomes after surgery between the two graft options. The results of this meta-analysis indicated that the use of bone-patellar-tendon-bone autografts offers improved rotational stability, and allowed a greater proportion of patients to return to preinjury level of activity. However, the four-strand hamstring tendon group experienced a lower incidence of anterior knee pain and kneeling pain.