The anterior cruciate ligament (ACL) is the key stabilizer of the knee joint, which prevents the anterior displacement of the tibia relative the femur and rotational instability of the knee joint. Proper understanding of its complex anatomy, function and biomechanics, mechanism and the type of ACL injury is of great importance in choosing a treatment strategy. Findings of clinical tests and imaging methods have a significant value in the diagnosis of anterior knee joint instability. Considering all the variety of currently existing techniques and implants for operative treatment of anterior knee instability, the clinical practitioner should make the right choice of a method or combination of methods for surgical ACL reconstruction in a specific patient, taking into account individual risks of gonarthrosis. The goal is to ensure knee joint stability with the least invasiveness to allow the patient to return to the preoperative level of physical activity as soon as possible.