40 patients scheduled for arthroscopic anterior cruciate ligament reconstruction with a semitendinosus graft or semitendinosus and gracilis graft, were randomized to have the tibial insertion of the graft preserved or resected. The purpose of this study was to evaluate graft ligamentization and integration on MRI at 6 months, as well as clinical outcome measures up to 2 years postoperatively. Grading of graft ligamentization at 6 months favoured the group which received preservation of the tibial insertion. Clinical outcome results appeared similar between groups after 2 years.