Anterior cruciate ligament (ACL) injury is a common soft tissue injury of the knee joint, often caused by non-contact or contact violence. Currently, arthroscopic ACL reconstruction is considered the gold standard for treating this injury. Various surgical techniques are available for ACL reconstruction, and postoperative recovery is influenced by multiple factors, including the preservation of the ACL remnant, graft selection, fixation methods, single-bundle versus double-bundle reconstruction, and femoral tunnel drilling technique. Therefore, this article provided a systematic review of the anatomical characteristics of the ACL, traditional and emerging diagnostic methods for ACL injury (such as high-resolution MRI, ultrasound, artificial intelligence-assisted diagnosis, and biomarkers), as well as aspects related to remnant management during reconstruction, graft selection and fixation, single-versus double-bundle reconstruction, femoral tunnel drilling techniques, and combined reconstruction of the anterolateral ligament.