Anterior cruciate ligament (ACL) injuries are common in sports involving jumping, sudden changes of direction, and pivoting, and they can significantly impact an athlete`s career. Diagnosis relies on physical examination, magnetic resonance imaging, and, when necessary, arthroscopy. Treatment is based on anatomical and individualized ACL reconstruction tailored to the athlete`s anatomy, sport, and performance goals. Patellar tendon autografts demonstrate high return-to-sport rates and low graft failure, particularly in younger and elite athletes. Hamstring autografts, while associated with higher graft failure and persistent laxity compared to patellar tendon, can benefit from adjunctive lateral extra-articular procedures to enhance rotational stability in high-risk athletes. Recently, quadriceps tendon autografts have gained popularity and provide reliable clinical outcomes and return-to-sport rates comparable to patellar tendon. Return to sport should be considered as a gradual recovery of pre-injury performance, guided by a multidisciplinary team. Due to the unique characteristics, physical demands, and expectations of different sports and athletes, outcomes after ACL injury management may vary. Although anatomical and individualized ACL reconstruction demonstrates favorable results, large-scale and long-term studies are needed to better understand its long-term effects.