Anterior cruciate ligament reconstruction by free patellar tendon graft was performed using 2 different surgical approaches to the intercondylar notch in 67 consecutive patients with chronic anterior cruciate ligament insufficiency. In the first 30 patients (Group A), the traditional medial parapatellar arthrotomy with lateral luxation of the patella was done, whereas in the last 37 patients (Group B) a transpatellar tendon approach was used. Postoperative pain was managed by analgesics and, in patients who had epidural anesthesia, by administration of bupivacaine in indwelling catheters. Generally, the analgesics and bupivacaine were given immediately on request to establish comfort at rest and to permit range of motion exercises without severe pain. Compared with those in Group A, the patients of Group B had a significantly longer period from the first dose of analgesic or bupivacaine to the second, and the total number of doses of analgesic or bupivacaine was significantly lower. In the subgroup of patients with epidural anesthesia (21 in Group A and 32 in Group B), the Group B patients required significantly less analgesics, as doses equivalent to 10 mg of morphine, compared with that of Group A.