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Indeed we have an unfortunately large number of failures - many of which are due to surgical mistakes. A critical and often overlooked part of performing an ACL reconstruction is to analyze all of the associated structures : What is the role and importance of the socalled anterolateral ligament or the anterolateral complex ? How much do surgical technique, graft choice, tunnel location, and fixation methods influence outcomes ? What is the role of biology and the menisci in restoring stability ? Finally, what impact do rehabilitation, proprioception, muscular control and strength, and neurologic control have on return to sport following ACL reconstruction.