Two-incision or rear-entry anterior cruciate ligament (ACL) reconstruction has value from a historical perspective as the original method for arthroscopically assisted reconstructions. As endoscopic approaches became popular it became less commonly utilized. It remains an important technique and has become even more relevant as the discussion of tunnel placement has evolved. It allows independent placement from the tibial tunnel and can be easier to accomplish than anteromedial tunnel drilling. It has also gained favor as a technique to ease performing revision reconstructions following previous endoscopic reconstructions. This review discusses the historical and clinical issues involved with two-incision ACL reconstruction.