The optimal graft choice for ACL reconstruction remains a hotly debated topic. Recent evidence continues to make a case against hamstring autograft, especially in high-risk populations (females, elite athletes, generalized hyperlaxity), due to higher re-tear rates and increased risk of persistent laxity. Quadriceps tendon autograft (quad) is gaining more support with favorable biomechanic characteristics (tensile strength and increased cross-sectional area) and re-tear rates similar to the "gold-standard" bone-patellar tendon-bone graft (BTB). In addition, the reemergence of lateral extra-articular tenodesis as an augmentation technique has demonstrated some protective effects in the setting of revisions and high-risk patients. Combined procedures are likely to be the most reliable way to provide stable long-term outcomes, especially with hamstring autograft, but BTB and quad is more robust. I resolved to fix it in a nearly, but not quite, straight position with a strong flat steel spring.