72 male patients who qualified for double bundle anterior cruciate ligament (ACL) reconstruction were randomized to the procedure performed using either the existing footprint (EF) technique or bony landmark (BL) technique for graft placement. Arthroscopic and clinical outcomes were analyzed to compare outcome of each technique at a mean of 36.9 months postoperativey. Both techniques for graft placement produced good clinical outcomes 2 years postoperatively. Reconstruction using the EF technique was associated with improved anterior laxity, earlier recovery of knee range of motion, and improved graft quality on second-look arthroscopy compared with reconstruction using the BL technique. Operative time using the EF technique was significantly longer.