A meta-analysis published in the Chinese Journal of Orthopaedic Trauma concluded that the incidence of autologous patellar tendon and 4-femoral N-cord tendon graft failure and passive extension deficit of the knee were similar. The incidence of anterior knee pain, knee kneeling pain, or discomfort was higher early in the follow-up of autologous patellar tendon grafts, but converged with time (5 to 10 years). Investigators from Southern Hospital and others searched major Chinese and English medical databases to obtain 14 randomized controlled trials (RCTs) of autologous patellar tendon versus 4-femoral N cord tendon graft for anterior cruciate ligament (ACL) reconstruction in a total of 1232 patients, and performed a meta-analysis to compare the differences in graft failure rate, knee extension deficit, and anterior knee pain between autologous patellar tendon and 4-femoral N cord tendon graft for ACL reconstruction. The results showed that the differences in graft failure rates between the autologous patellar tendon group and the autologous 4-strand N cord tendon group were not statistically significant at a mean follow-up of 2 to 3 years, 5 years, 10 years, and after consolidation. There was no significant difference in the number of cases of knee extension deficiency ≥5° compared between the two groups. There was a statistically significant difference between the two groups for anterior knee pain at 2 years of follow-up, while there was no statistically significant difference at 5 years of follow-up and at 10 years of follow-up. There was a statistically significant difference between the two groups for knee pain or discomfort at 2 years of follow-up, while there was no statistically significant difference at 5 years of follow-up and at 10 years of follow-up.