116 patients scheduled for anterior cruciate ligament reconstruction were randomized to an autologous hamstring tendon graft with or without supplemental augmentation, with cartilage fragments sutured within the femoral side of the graft. The purpose of this study was to determine if augmentation with cartilage fragments led to reduced femoral tunnel widening after 2 years. MRI assessment of the graft, including signal intensity and signal-noise quotient, was also performed, and clinical scores were obtained. Results for the primary outcome demonstrated a significantly lower percentage of femoral tunnel widening from immediately postoperatively to 2 years in the group treated with the cartilage fragment augmentation.