An anatomical cadaveric study was performed in 111 knees to evaluate the macroscopic appearance of the tibial midsubstance of the ACL and its tibial insertion. The ACL was flat like a ribbon with a “C”-shaped tibial insertion along the medial tibial spine to the anterior aspect of the anterior horn of the lateral meniscus. Three variations of the tibial insertion were found. The bony insertion of the anterior horn of the lateral meniscus is in the center of the “C”-shaped tibial ACL insertion. Fibers of the anterior and posterior horn of the lateral meniscus blend with the tibial ACL insertion.