There are approximately 200,000 anterior cruciate ligament (ACL) injuries per year in the United States and more than half will be treated with ACL reconstruction. The diagnosis is made by physical exam supplemented by radiographs and MRI scan. Successful ACL reconstruction returns most athletes to pre-injury activity; however, outcome depends on appropriate preoperative evaluation, surgical timing, surgical technique, and an effective postoperative physical therapy program. Specifically, graft choice, graft positioning, and fixation technique have been shown to play important roles in patient outcome. Surgeons must also be aware of concomitant meniscal tears and cartilage injury that may need to be addressed at the time of ACL reconstruction. In this case, we perform an anatomic ACL reconstruction with bone-patellar tendon-bone (BTB) autograft using an anteromedial drilling technique and flexible reamers for a young college athlete. The anteromedial approach offers the advantage of reliably reproducing the native anatomy of the ACL on the femur footprint by drilling the femoral tunnel independently of the tibial tunnel. Furthermore, using a flexible reamer instead of a straight rigid reamer allows for a longer femoral tunnel and lower risk of posterior wall blowout or fracture.