Anterior cruciate ligament (ACL) reconstruction is the sixth-most-common orthopaedic surgery. It is widely accepted that ACL reconstruction improves stability and function of the knee and reduces risk for chondral and meniscal injuries. During the past decades, a significant improvement in ACL reconstruction techniques has been observed, evolving from extra-articular to intra-articular techniques, from open to arthroscopic procedures, and from nonanatomic to anatomic reconstructions. However, the ideal ACL reconstruction technique is still debated, and residual anterior and rotatory instability is a common finding after anatomic ACL reconstruction. Although the classic concept of anterolateral rotatory knee instability developed by Hughston implied a combination of injuries to both the ACL and the “anterolateral stabilizing structures,” this notion has become obsolete under the boom of arthroscopic surgery.To date, the enigma surrounding the ligamentous structures of the anterolateral aspect of the knee is reflected in confusing names such as “lateral capsular ligament,” “capsulo-osseous layer of the iliotibial bad,” or “anterolateral ligament,” and no clear function has been attributed to it. The high incidence of anterolateral ligament lesions seen on MR images of ACL-injured subjects and its causative relationship with high-grade pivot shift prompted researchers to further investigate the anatomy and function of the anterolateral ligaments of the knee and understand the interaction between the anterolateral ligament and ACL. In this scenario, a return to extra-articular anterolateral tenodesis combined with classic ACL reconstruction can be hypothesized. In the present multimedia presentation, the authors describe the surgical technique of ACL reconstruction with over-the-top position of the graft and lateral extra-articular tenodesis. Topics regarding the above-mentioned technique will be discussed, including Indications, setup of the patient and examination under anesthesia, a step-by-step description of the surgical technique and postoperative regimen, and results reported in the literature.The authors conclude that the over-the-top plus lateral tenodesis technique is easy and inexpensive, using only three staples for fixation. This technique represents a valuable option for ACL revision surgery (with autologous hamstrings or allografts), posing no worries about femoral tunnel drilling or the graft fixation both proximally and distally. The technique showed good short- and long-term results, with the advantage of reducing rotatory instability. This technique is not anatomic and there is no evidence of superior results compared with conventional ACL reconstruction techniques. In addition, discomfort at the proximal staples level is common and hardware removal often is required. Lastly, this technique is not recommended in patients with short stature because the graft might not be long enough.