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This study examined the effect of the initial graft tension on the clinical outcome of anterior cruciate ligament reconstruction in a prospective randomized design. Fifty patients were enrolled in the study. In the reconstructive procedure, a bone-patellar tendon-bone graft was used. A set force of 25 N (5.6 lb) was applied in 25 patients and 50 N (11.2 lb) tension was maintained during fixation for the remaining 25 patients with the knee in full extension. In the immediate postoperative period, the anterior cruciate ligament reconstructed knee was similarly overconstrained in both groups. At 3 months, laxity of the surgically treated knee in both groups had increased significantly and become close to that of the contralateral knee. Measured laxity value showed a slight increase between 3 and 6 months, and remained similar thereafter. No significant difference in the clinical outcome was observed between the groups throughout the followup.