Anterior cruciate ligament (ACL) reconstructions cannot, and should not, be considered "recipe-driven" or "cookie-cutter" operations. There are multiple variables that must be considered both pre- and intraoperatively in order to execute a successful procedure. The following case studies present a number of challenging situations, many of which do not have a straightforward, or only one, solution. The goal is to provide some ral-life clinical situations in which the reader can "observe" an expert panel of ACL surgeons working through the problems--offering solutions based on science, experience, and intuition.