Anterior cruciate ligament (ACL) injury is a common reported injury in an athlete. Historically, with the first description of the structure of ACL in 150 AD, the surgical repair and reconstruction techniques have evolved. Over the years the ACL surgery was done as direct repair, reconstruction, anatomical repair, intra-articular repair and extra-articular repair. This narrative review will discuss the different modes and techniques used for surgery chronologically, the challenges and outcomes with regard to the surgery, and the latest techniques used to improve patient outcome.