45 patients scheduled for anterior cruciate ligament reconstruction with a semitendinosus and gracilis autograft were randomized to the surgery with or without preservation of the tibial insertion of the graft. The primary purpose of this study was to assess and compare graft maturity on MRI over the first 24 months after surgery. In addition, clinical score and knee laxity measures were assessed. Results demonstrated significantly lower signal-to-noise quotient of the graft in the tibial insertion preserved group at 6 and 12 months follow-up, while difference at 24 months was not significant. Clinical scores and knee laxity measures did not significantly differ between groups at any time point.